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Gender News 2016

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Q&A – David Odali: Involving men to prevent HIV in women in Malawi

Published at
08 March 2016
Couple attending PMTCT services

David Odali, director of the Umunthu Foundation, AVERT’s partner in Malawi, offers insight into his experiences of working with men to help reduce local women’s vulnerability to HIV. A Q&A for International Women’s Day.

What makes women particularly vulnerable to HIV in Malawi?

Gender inequality and gender-based violence. It is the man who has the final decision as to whether they use condoms, and the women cannot negotiate for safer sex. The man has more strength over a woman, so they accept.

If a woman tests positive for HIV at the antenatal appointment, when she goes back to the husband, he may very quickly divorce her. He pushes the blame for bringing HIV into the home to her.

If the man does not divorce her, often that man does not go for HIV testing. He will go only when and if he gets sick.

We also have a problem that women are vulnerable to contracting HIV as they walk long distances to fetch firewood or water. They sometimes start off their journey early in the morning at dawn when walking becomes dangerous. They can either be attacked sexually – they can be raped – and some men also propose [approach] them.

How does this increased vulnerability affect women’s access to HIV services?

Number one, they lack the support which they need from men, from their husbands. Which in the first place, makes them vulnerable.

Number two, when a woman tests HIV-positive, men, instead of supporting them and confronting the challenge together, will sometimes place the blame on the women and [we see a] continuation of domestic violence at home.

We are talking about a lack of strong male involvement in HIV services that affects access to services.

What role can men play in reducing women's vulnerability to HIV?

We need that male involvement. How do we get it? By involving men themselves, and targeting men with awareness messages on the importance of supporting women and girls with regards to HIV.

We need to also come up with supportive attitudes about gender equality. We need men to stand up and go to the forest to get firewood, or to get water. If we have gender equality in our minds, we will be able to support our women and wives.                                      

I hear you were involved in the launch of the ‘He-for-She’ campaign in Malawi? How did that come about?

Yes, last week we launched the United Nations ‘He-For-She’ campaign, which calls upon men and boys to take a role in the promotion of social programmes which must benefit women and girls in gender equality in the areas of education, health, work, politics, identity etc.

We are part of a network called 'Men for Gender Equality Now' here in Malawi. This programme targets men, so that men can change their negative attitudes towards women and girls, and embed gender equality as the norm.

There is an African proverb that says - you have to send a thief, to catch a fellow thief.

That is why it is important to involve men, who are perceived to be the perpetrators of gender inequality and gender-based violence. We work with these men, so that they can change their negative attitudes towards women and girls. Men can also more easily convince their fellow men.

So how do you involve men in PMTCT?

We encourage the husband to give full support to their pregnant wife, by escorting them to any clinic appointment relating to the pregnancy. We also encourage men to be present on the day of the birth – even in the theatre. We try to popularise a policy of more male involvement.

We encourage men to be more loving throughout the period of the pregnancy, and to resist from committing physical violence against the wife.

If the wife tests HIV-positive, we also encourage the husband to be supportive, and to follow all tips that had been given, for example, the use of condoms, because it is now the wife that has the challenge of living with HIV.

How do you support expectant mothers when there may be a risk of domestic violence?

We work with the victim support unit of the police station. Through psychosocial counselling, the abusive husband can understand the wrongs of committing physical violence. Psychosocial counselling is also given to the victimised woman, so that she can restore her confidence after going through the violence. But when we see that that the husband has caused grievous bodily harm, then it will become a crime.

As well as HIV services, we provide legal support services. We have several cases in our offices, some have been taken to court and I am handling them.

Psychosocial counselling is very important because we have another very common domestic violence practice here – wife and children abandonment. A husband can abandon his wife, even with eight children, small ones, go to the next village and marry a young woman there.

We provide psychosocial counselling, both to the abandoned woman and also to the husband. But if the husband is not compromising, then we take this matter to the court, to secure maintenance for the children.

What is your message for International Women’s Day?

We should support proactive interventions that support male involvement in decreasing gender inequality. Because it is only by involving men that these new interventions can create more impact. But if we leave men out, men are perceived as active in gender inequality and gender-based violence, then the initiative will not be successful. My call is to try to, at all levels, involve men and support initiatives that involves men and boys.  

Photo credit:
© AVERT/ Corrie Wingate. Photos used for illustrative purposes only and do not imply the health status or behaviour on the part of the individuals in the photo.
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Empowering Women to Prevent HIV Infection in Africa 05/04/2016

Published at

05 April 2016

A version of this story was first published on

Quarraisha Abdool Karim has been presented with a l’Oréal–UNESCO For Women in Science award for her contribution to the understanding of HIV and for her efforts to empower women to help prevent HIV infection in Africa.

Ms Abdool Karim has worked on HIV research for the past 25 years and her work has provided new insights into how the HIV epidemic spreads and affects adolescent girls and young women in Africa. Her knowledge of the science and the people affected by HIV in her native South Africa, which has the highest number of HIV infections in the world, has reinforced her determination to put HIV prevention in the hands of women, particularly adolescent girls and young women.

In 2002, at the height of AIDS denialism in South Africa, she and her husband cofounded CAPRISA, the Centre for the AIDS Programme of Research in South Africa.

Ms Abdool Karim has undertaken research on an anti-HIV gel for use by women before, during and after sex. In 2010, the CAPRISA 004 study, led by Ms Abdool Karim, showed that a gel containing the antiretroviral medicine tenofovir reduced the risk of HIV infection among women by 39%. Today, she continues to study HIV prevention options that will give women in higher-risk populations sustained protection against HIV.

Until we have eradicated AIDS by finding a vaccine or a cure, then I think my job is not done,” said Ms Abdool Karim.

The L’Oréal-UNESCO For Women in Science programme was founded in 1998 with a simple aim: to ensure that women are fairly represented at all levels in science. Each year, the programme’s award is presented to five outstanding women researchers in recognition of scientific excellence and their potential for leading the global community in positive, productive directions.

“I would encourage young women who feel passionate about changing the world and making a difference to pursue a career in science,” said Ms Abdool Karim at the French Academy of Sciences, where she was presented with the award.

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CSW60: Preventing Gender Based Violence. 4/4/2016

At the 60th session of the UN Commission on the Status of Women (CSW60) last month, the Alliance turned the spotlight on the CSW theme of Empowerment and the links between non-conforming sexual orientation or gender identity among women and the heightened risk of violence and HIV.

Women living with HIV; women who have sex with women; lesbian, bisexual and transgender women; female sex workers and women who use drugs experience heightened risks of and vulnerabilities to VAW and HIV. These groups, described as Women in their Diversity are further characterised by sexual identities and behaviours that do not conform to the traditional definition of women. 

“These women face additional discrimination, criminalisation, stigma and marginalisation, and have limited access to resources to respond to these challenges. The evidence is clear. Non-conforming sexual orientation or gender identity is linked to a heightened risk of violence”, said Claire Mathonsi, the Alliance’s regional representative for gender based violence.


At the CSW60 - the principal global intergovernmental body exclusively dedicated to the promotion of gender equality and the empowerment of women - the Alliance co-hosted two events. 

The first, a panel discussion - Achieving Empowerment for Women in their Diversity in the context of HIV – was co-organised by our new in-coming Linking Organisation AIDS Legal Network in South Africa, and partners from the Alliance-led Link Up project – including The ATHENA Network and a number of youth advocates. 

The session highlighted the gaps in inclusion and empowerment of Women in their Diversity at CSW and in prevention and treatment services for women in their diversity due to social and legal marginalisation and exclusion, and raised specific advocacy calls for more inclusion and empowerment for women in their diversity. 

A second event, Criminalisation, Women and HIV: Redefining the decriminalisation agenda was the 5th in a series of dialogues entitled From Criminalisation to Agency: African women’s voices on HIV and human rights. Co-organised by ALN, the ATHENA Network, the International Community of Women Living with HIV (ICW) and ACCESS Chapter 2, this lively debate gave delegates a unique opportunity to renew, build and expand on the call for decriminalisation.

Throughout the CSW60, the Alliance drew attention to its main calls for action:

  • Comprehensive sexuality education (CSE), in light of overwhelming evidence about how it can help curtail HIV, other sexually transmitted infections, and teenage pregnancy.
  • Sexual and reproductive health and rights (SRHR), rather than relying on the ‘partial language’ of sexual and reproductive health and reproductive rights which fails to account for the full scope of rights, including the right to the highest attainable standard of health.
  • Attention to challenging and changing harmful gender norms in order to achieve gender equality and the empowerment of women.
  • Recognition of the diversity of women, women living with HIV and women in key populations.  These are precisely the groups who are most at risk of, most vulnerable to, and most affected by the gender dimensions of HIV.
  • Young people’s rights to privacy, confidentiality, respect and informed consent.
  • Acknowledgement of the bi-directional causality between intimate partner violence and HIV
  • Greater understanding of HIV-TB co-infection and cervical cancer as these are growing concerns for women living with HIV.

Following the meeting, UN Member States committed to “the gender-responsive implementation of Agenda 2030for sustainable development”. A set of agreed conclusions called for rapid progress, including stronger laws, policies and institutions, better data and scaled-up financing. They acknowledged that progress on the Sustainable Development Goals at the heart of Agenda 2030 will not be possible without gender equality and the empowerment of all women and girls.

However, for us, there were significant limitations to the final statement. Claire Mathonsi said, “The text was not progressive in many of the areas we were calling for, such as SRHR, CSE and key populations. We also have concerns about the lack of political will and ambition to push the agenda forward – for example, in discussing sexual orientation and gender identity. Based on this watered-down text, we anticipate significant challenges at the forthcoming UN High-Level Meeting on AIDS where governments will commit to meeting UN goals to ending AIDS by 2030.

That is why the Alliance must increase its investment in efforts to build the capacity of civil society organisations to lobby and advocate at national and regional level, and to hold Member States accountable in global mechanisms.

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Ending HIV in Women and Girls. 10/3/2016

Published by NCAAN

35 years into the HIV/AIDS epidemic, I’m afraid many of us still hold the same misconceptions and stereotypes that were prevalent in the early days of this disease; such as HIV/AIDS is a disease that occurs exclusively among men who have unprotected sex with other men. And men in the United States are still diagnosed at higher rates than women. But nationally, about 25% of people livingwith HIV are women, and the vast majority of them contract the infection from heterosexual contact.  In North Carolina, 29% of those living with HIV are women, and black women have the highest rate of infection. While messages of practicing safer sex and addressing risky behaviors are good educational strategies for preventing transmission, we can’t ignore the larger cultural norms that can make women vulnerable to HIV in ways that many men may not be.

On National Women and Girls HIV Day, we take the opportunity to shine a light on this vulnerability, allowing us to develop more effective prevention methods. One vulnerability is the incidence of domestic and sexual violence many women face over their lifetimes. While men and boys can also experience this violence, women are much more likely to (particularly sexual violence). What does this mean in terms of HIV infections? Women who are in abusive relationships may have a difficult time negotiating condom use or safer sexual practices; and they may not always be able to negotiate consensual sex. Women who have experienced/are experiencing domestic and sexual violence are more likely to abuse drugs/alcohol, making them more susceptible to the risky behaviors that increase their risk of HIV infection. And in a vicious cycle, it’s been found that as women in abusive relationships are at a higher risk of contracting any STI, including HIV, those women living with HIV are also more likely to experience domestic violence.  And HIV+ women who are experiencing abuse have more health problems (such as depression) and a more difficult time managing their status than their counterparts who are not experiencing such violence.  

There are many effective strategies we can take to reduce these risk factors for women, including providing children and adolescents comprehensive, medically-accurate sex education that addresses consent and domestic/sexual violence. We also need to change our cultural norms that allow sexist and misogynistic violence to go unchallenged; and we need to hold abusers accountable for their actions. And in North Carolina, we can also expand Medicaid as an effective strategy in reducing risk. Not only will this provide women increased access to health care, HIV testing and treatment, and mental health services, but increasing access to our health care system can be an effective tool in preventing domestic violence.  35 years into this epidemic, we need to use every tool we have as we move closer to our goal of raising an AIDS-free generation. 

- Tara Romano is the President of NC Women United

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Gender News 2015

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Engaging Men to Integrate Gender into Existing HIV Programmes. 14/12/2015

Published at

8 December 2015

In Africa, traditional gender roles often leave women with the sole burden of caring for those living with HIV-related illnesses. Gender inequality and gender-based violence (GBV) prevent many women, particularly young women, from protecting themselves against HIV. As the latest data from UNAIDS continues to show, young women, and adolescent girls in particular, account for a disproportionate number of new HIV infections among young people living with HIV.

And in the work environment, gender norms and inequalities leave many women feeling unsupported and unable to take on leadership roles.

The Organisation for Social Services for AIDS (OSSA) in Ethiopia is currently one of five Alliance Linking Organisations implementing Link Up, an ambitious project which is improving the sexual and reproductive health and rights (SRHR) of more than one million young people in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda. In October they offered training on gender sensitivity for their male staff members in Bishoftu/Debre Ziet.

The training aimed to acquaint the participants with the basic concepts around gender sensitisation, and to highlight how gender inequality can hinder the contributions of women in the communities in which they live.

Ethiopia training

More than 35 participants took part. The participants were selected from all branches of OSSA across Ethiopia, as well as male staff members from the head office in Addis. They discussed the concepts of sex, gender, gender equality and equity, the feelings of patriarchy and masculinity, and their consequences. Gender roles in different societies, along with case studies of different community experiences were used as a basis for exploring men’s attitudes to women, and to contribute towards changing behaviours.

The training was conducted by the South African National AIDS Council (SANAC) Men’s Sector Coordinator, and Brothers for Life Ambassador, Rev. Mbulelo Dyasi.

“Due to the feelings of patriarchy and masculinity that prevail in the family and the communities many of us live in, women experience a lot of challenges. In many societies, women are considered as wives and mothers, nothing else. They are denied access to education and training opportunities, equal work for equal pay. Many devote their lives to raising children, often alone, and to working for others.”

“Some women also face physical harassment, rape and beatings by their friends and husbands. This is because they are raised to accept the idea of male superiority, self-sacrifice and self-negations in the family as well as in the society.”

Rev. Dyasi stressed that men needed to stand by the side of women. He emphasised that men could do a great deal to facilitate women’s access to assets, resources, knowledge, skills and income in order to ensure their full economic participation in society.

Participants discussed the role of women in OSSA. They were encouraged to do more to support their colleagues to achieve leadership positions by creating an environment that was conducive for women to work in and in which they could succeed. 

The training ended with recognition that women also need support. Rights-awareness programmes can empower women to exercise their right to control their own lives in matters of marriage, reproduction and livelihood.

It is hoped that the participants will start to bring about change in their own roles at home and at work; they will inspire policies that favour women and motivate them to take part and contribute their share at household and community level.

Further training is planned to take place in other Alliance Linking Organisations, and is part of Alliance efforts to mainstream awareness of gender equity and the impact of gender based violence across all its programming under its 2020 strategy.

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New ICRW research highlights challenging facing girls living with HIV in Zambia. 11/12/2015

Published at

Written by Erin Kelly

9 December 2015

Today in Washington DC, the International Center for Research on Women released new research that highlights some of the challenges facing adolescent girls growing up with HIV in Zambia, where nearly six percent of girls ages 15-19 are living with HIV.

Previous research has found that adolescents living with HIV in Zambia have difficulty adhering to their medication, disclosing their status to family and friends and coping with stigma. Despite this research, very few community or clinic-based programs are designed to support girls’ healthy transition from adolescence into adulthood.

To fill this gap, ICRW interviewed 24 adolescent girls living with HIV in two different health centers in Lusaka, Zambia through participatory workshops and in-depth interviews.

At the individual level, ICRW found that girls living with HIV said their health status was not going to hold them back, but they faced myriad challenges, including a lack of support to cope with emotional needs, a lack of tools and advice on how to disclose their status and to whom, a fear of experiencing stigma if their status becomes known, challenges around taking their treatment and gaps in knowledge about HIV.

All participants in the study acknowledged they knew it was important to adhere to their anti-retroviral drugs (ARVs), but noted that they faced challenges in taking their medication, especially when social events overlapped with medication times, exposing them to the possibility of others finding out they were HIV positive.

The girls interviewed said that there were gaps in knowledge around HIV, especially around how HIV is transmitted to sexual partners. Girls were unaware that being on ARVs greatly reduces the chance of passing on the virus to a sexual partner, but few clinic staff and adolescent counselors mentioned that because they feared it would encourage the girls to be sexually active.

“It was clear in talking to the girls that too often, they are given misinformation, or very little information regarding their sexual health, which inhibits girls’ ability to talk openly about their sexuality and ask important questions about entering into relationships as they get older,” said Anne Stangl, senior behavioral scientist and the lead researcher on this study.

At the inter-personal level, girls noted that family provided vital support and encouragement, but that they often had a lack of detailed knowledge about HIV, including how HIV is transmitted. In some cases, girls reported guardians moving them away from other children in the family or providing them with separate cups, plates, and clothes.

At the institutional level, those interviewed said they were generally happy with their clinical care, but they reported several concerns, including long wait times and administrative challenges, fears around being seen by people they know, and limited access to neutral information about sexual health. Some girls mentioned wait times so long they had to miss full days of school in order to adhere to their treatment. At schools, girls mentioned that teachers themselves often provided incorrect information about how HIV is transmitted, making the girls feel sad and uncomfortable.

Overall, the research highlighted that despite the challenges, girls living with HIV in Zambia want what all girls want: to hang out with their friends, go to school, be in relationships, and think about their future. The results from our research point to a number of interventions that would enhance their ability to do just that, through strategic support and changes at several different levels:

  • Individual level
  • Create opportunities for adolescents living with HIV to engage individually with other adolescents living with HIV to create a broader support system for them; and
  • Disseminate new sources of information on sexual health and HIV transmission that can be accessed discretely on the internet or throughout clinic waiting areas.
  • Interpersonal level
  • Develop information sessions and counseling support for parents and guardians of adolescent girls living with HIV to help increase their knowledge about HIV.
  • Institutional level
  • Implement procedural changes at the clinic to reduce wait times;
  • Train adolescent counselors on discussing sex in a neutral way;
  • Train and supervise teachers to integrate existing curricula on sexual and reproductive health and HIV-stigma reduction in schools; and
  • Implement school-wide campaigns promoting compassion and support for people living with HIV.

“These recommendations don’t require a ton of investment or even a huge burden of time,” said Stangl. “Girls living in Zambia are dreaming of bright futures, despite their HIV status, but it’s up to us to make sure that the barriers they face don’t inhibit their ability to fulfill their dreams.

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This World AIDS Day, Let's Redefine What It Means to Be a Man. 9/12/2015

Published at huffingtonpost

Written by Garry Barker

2 December 2015

In a training course for public health workers in Brazil a few years back, I asked the health educators -- more than 90 percent of whom were women -- why it was so difficult to get men to come to health clinics. A female health educator responded: "Men only come to see us when something is falling off."

We all laughed. But our laughter masked a very serious issue. Around the world, men's health -- and how they do, or rather don't take care of it -- is a problem, and a growing one. Men die about six years earlier than women do, a difference that has increased in the past 40 years. We are over-represented in the top 10 causes of global disease burden and years of life lost due to ill health. And in much of the world, we are less likely to seek preventive health care than women are.

What's to blame? Research suggests that a small difference in life expectancy between women and men may be physiological; women's bodies have some genetic advantages over men's. But the vast majority of this life expectancy gap is related to how we are raised and what is expected of us as real men. Often, we're taught that a real man is 'hard,' doesn't care too much or seek help, doesn't tolerate disrespect and has a lot of sex with a lot of partners. And the impact of this on men's lives has disastrous health consequences: violence, alcohol use, unsafe sex, tobacco, other risk-taking behaviors and occupational issues can lead to early death and disease. To offer one stark example: in 2010, 3.14 million men − as opposed to 1.72 million women − died from causes linked to excessive alcohol use.

On World AIDS Day (December 1), part of the plan to achieve a world free from HIV and AIDS must include taking a closer look at men's health -- and, particularly how the way we're raising men and boys can set our efforts back. In the past years there has been nothing short of a revolution in how HIV and AIDS are treated, leading to an impressive reduction in how many people die from AIDS-related causes around the world. The expansion of AIDS treatment (ART) in Eastern and Southern Africa has been particularly notable, with 8.1 million people, or 44 percent of all people living with HIV, on treatment as of 2014.

Yet although the global picture is improving, men are still lagging behind women in both HIV testing and treatment in every region of the world. Across 23 sub-Saharan African countries, men are only a third of those receiving ART; in other words, women are twice as likely to be getting treatment as men are. Across the African continent, which has been the hardest hit by HIV and AIDS, men begin their treatment later, are less likely to adhere to treatment plans and are dying earlier from AIDS-related complications than women are.

In the US, the biggest challenge, and most at-risk group for new HIV infections are men; specifically gay, bisexual and other men who have sex with men (MSM) account for nearly two-thirds of new HIV infections. Young MSM, and young black MSM are particularly at risk. And while testing and treatment have been widely available in the US, an estimated one in eight of all HIV-positive persons in the US are not aware of their status.

So, in preventing HIV and AIDS, should our national and global health focus shift to men instead of women? No, that clearly is not the answer. We know that young women are particularly at risk of becoming infected by HIV; and among heterosexual women and men, women are infected at higher rates than men are. This is due to sexual coercion, exploitation and violence; and because far too many women lack autonomy and equality in their intimate and sexual relationships with men. In short, the behavior of men too often puts women at risk.

At the heart of this issue are harmful ideas about manhood and the lack of attention to men's health -- by men, and by the public health sector -- which create risks for women and men. Indeed, study after study tells us that when men equate masculinity with dominance over women, sexual conquest and alcohol consumption, and when women are expected to acquiesce to men's sexual advances, it is difficult for women and girls to protect themselves from HIV. What happens in the lives and to the health of men directly affects women.

For years, the global attention on HIV and AIDS has been on women and girls, and with good reason. Much more needs to be done to protect and support women, particularly young women and girls, in ensuring that their sexual health and sexual rights are fully met.

What's the solution? Community-based programs like Sonke's One Man Can approach in South Africa have shown success by using community health promoters to talk to men to question rigid norms about manhood and encourage men to go for HIV testing. In Brazil and other countries, Promundo's Program H uses group education and youth-led community outreach with young men -- and young women -- to question ideas that equate manhood with risk-taking. Studies have shown the program leads to reductions in sexual-risk-taking.

There are also things the health sector can do. Brazil has been a global leader in making the health sector friendlier to men. Started in 2007, the Men's Health Initiative run by Brazil's Public Health Ministry is trying out creative ways to get men to come for HIV testing and preventive health care in general. One promising approach has been to invite men to accompany their pregnant partners for prenatal visits. Pregnant women are asked if they want to include their male partner, and if so, he is invited to join her. Then, he is invited to come back for a full check-up for himself, including getting tested for HIV. The program has achieved rates of up to 80 percent of expectant fathers who come back in for a check-up and get tested for HIV.

If the promise of an AIDS-free world is to be achieved, we must focus our efforts on getting men -- and women -- to get tested for HIV and to come for treatment. We must also focus on prevention, and challenging the norms that not only discourage help-seeking, and gender equality but that also encourage violence and risk-taking.

This year, on World AIDS Day, it's time to think about how to get men to come to clinics for testing and treatment, and to see the importance of prevention. It's too late for most men to seek health services, as the nurse in Brazil told me, when "something is falling off." And the consequences are far too serious for us to laugh at it anymore. When health care providers reach out to men, and men seek preventive services, the health of women, children and men themselves improves.

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Welcome to Our house: Women Living With HIV. 9/12/2015

Pubished at opendemocracy

Written by Alice Welbourne

7 December 2015

The results of the largest ever international survey of women living with HIV were formally published last week and they do not make a comfortable read. The gender-based violence (GBV) and mental health issues faced by women living with HIV after their diagnosis are both very high and have a huge impact on their lives. This includes GBV in healthcare settings. Yet as the findings reveal, neither of these issues is being addressed by global policy makers.

The survey, which formed part of a global “values and preferences” consultation, is not the first of its kind, but is the largest, in terms of numbers and its international scale. Conducted in 2014, it was commissioned by WHO as they begin the process of updating their 2006 Guidelines on the SRH of women living with HIV. Furthermore, it represents a “first” in terms of using  participatory methods in WHO guideline development

The consultation, comprising an on-line survey and a series of focus group discussions, was led by Salamander Trust, with ATHENA, GNP+, ICW, and the Transgender Law Center, among others. A global reference group, made up of 14 women living with HIV from around the world and representing women from different backgrounds and contexts, conducted a pre-consultation to elicit priority themes to include in the survey, and helped roll out the survey among their networks and communities. Nearly 1,000 women living with HIV from 94 countries engaged in the survey, including sizeable numbers of women with experience of drug use, sex work, homelessness, prison or detention, rape or sexual violence, migration, and conflict, transgender and lesbian, bisexual and other women who have sex with women and heterosexual women.

“Before HIV, I was victim of different types of violence (physical, psychological, financial) besides the impact my partner’s alcoholism and machismo; this lead me to get several STIs, including HIV." (El Salvador).

The survey contained one introductory mandatory section and eight optional sections, covering different themes. Gender-based violence (GBV) was reported in all sections. Eighty-nine percent of 480 respondents to the optional section on gender-based violence (GBV) (58% of all survey respondents) reported having experienced or feared violence, either before, since and/or because of their HIV diagnosis. GBV reporting was higher after HIV diagnosis  from their intimate partner, or from family or neighbours, from the wider community, from healthcare settings and/or from police or prison staff. Whilst we have known for some time that violence against women is a factor that increases women’s vulnerability to HIV by 1.5, these results clearly confirm GBV in many contexts as a consequence of HIV also, with increased intimate partner violence (IPV) rates too.

“When I was newly diagnosed and had lost about 40Kg my neighbours and members of my church choir started avoiding me and in fact disallowed their children to come to my home and my son to enter theirs. It was such a painful experience for me." (Nigeria).

The respondents described a complex and iterative relationship between GBV and HIV occurring throughout their lives, including breaches of confidentiality and lack of sexual and reproductive health choice in healthcare settings, including forced or coerced treatments, human rights abuses, moralistic and judgmental attitudes (including towards women who identify as transgender, lesbian, bisexual, drug using and/or doing sex work), and fear of losing child custody.

“The moment a woman identifies herself as living positively with HIV, they are neglected especially during delivery hence increased number of children born with HIV because women prefer to keep it a secret and be treated like the rest. Others have avoided giving birth from health centers . . . because of negligence in those hospitals. They prefer traditional birth attendants." (Uganda).

Only 11% of all respondents to this section reported never having experienced GBV in any form. Respondents recommended that healthcare practitioners and policymakers address stigma and discrimination, training, awareness-raising, and human rights abuses in healthcare settings as a matter of urgency. The report authors note that gender-based violence is not something that is currently addressed meaningfully in any global policy that concerns issues relating to women living with HIV. Notably, this critique applies also to the just released  “2015 Progress Report on the Global Plan towards the Elimination of new HIV Infections among Children and Keeping their Mothers Alive”. In this report, it is very dispiriting  to see that violence is still not mentioned, despite others having criticized the Global Plan previously on that count and despite the report from the survey we are discussing here being widely available for the past 11 months.

‘‘I have lost friends, and have a hugely restricted social circle from before I was diagnosed with HIV.’’ (UK).

82% of our respondents reported symptoms of depression while 78% reported rejection. These results compared to 1/5 of respondents reporting mental health problems before diagnosis. 

“Family members are blaming me for the death of my husband,I fear to disclose my status to even my mother because she will isolate me from my siblings and use me as an example in every case.” (Uganda).

The respondents discussed how HIV-related stigma and mental health issues presented them with challenges both in engaging in and asserting agency and control within sexual/intimate relationships. They described both shame and fear as barriers:

“I have stopped engaging in sexual relationships since being diagnosed. I feel embarrassed and will never disclose to anyone.” (Nigeria).

“The issues around dating and having to talk to your lover or partner about your status at times brings anxiety, fear and depression of being rejected.” (Kenya).

Some women felt more vulnerable to unsafe sex as a result of their low self-esteem:

“It makes me less assertive and I sometimes give permission to my partner to take advantage of me by having sex when I would rather not.’’ (Nigeria).


The original survey report presented its findings using the metaphor of a house to show how all the issues addressed by the respondents are inter-connected. The image shows how SAFETY is placed as the deepest foundation. And mental health is one of the key roof sections. All these sections of the house are integrally connected in a woman’s life. In order to achieve their sexual and reproductive health and human rights, all these different aspects of a woman’s life need to be considered. As the report explains, there is both intrinsic and instrumental sense in seeking to achieve these rights: both in a woman’s own right, and - just like putting your own oxygen mask on first in an aeroplane - in order for her also then to be better placed to care for the children, partners and other community members for whom women around the world so often seek to care.

To separate all the different sections of a woman’s life into silos, whilst it may seem more convenient for policy makers and health-service or other providers, means that one rapidly loses sight of the bigger picture: of how the many, complex and inter-related challenges facing women living with HIV around the world connect with one another.  As the lack of any mention of GBV in the Global Plan report above shows, there appears within the UN to be a curious cognitive dissonance in its global policies around women in relation to their own happiness, health and safety and that of their children especially. In relation to HIV and children, there is some disconcerting mental slippage that assumes that the health and well-being of a child may somehow be completely unconnected to the happiness, health and safety of her mother; or that somehow the mother may indeed herself be carelessly to blame for the child’s problems.

Meanwhile, for those women with HIV who are not mothers or partners, there is instead a distinct paucity of health or any other services across the lifecycle. It therefore often appears that issues facing women with HIV are only to be addressed if their own HIV could potentially spread to others around them. Either way a woman with HIV gets short shrift.

At a meeting of the report developers with WHO in January 2015, the survey report was first presented to members of the Guidelines Development Group by several of the 14 women living with HIV from around the world who shaped this survey from its outset. The women shared their own stories to illustrate the personal dimensions of the report’s findings. This Guidelines Development Group will now take forward the process of updating the WHO Guidelines. They have listened to and engaged with the findings of the consultation; have heard from the mouths of women living with HIV their experiences, their realities and priorities in the areas of life course transitions; of the desire for positive sexuality; of experiences of violence and diversity; and of mental health matters. They have put themselves, for a moment, into the shoes of women living with HIV, and have walked around in them; and have imagined entering the loving warmth and security of our “house built on firm ground.”

“This has been the best part of all the guideline writing process. I was anxious about the whole process because it is usually quite a task, but after listening to your presentations I am not anxious at all anymore.” (Member of the Guidelines Development Group, WHO).

With two articles about the gender-based violence and mental health challenges faced by women living with HIV published last week in a leading scientific journal, we hope that the global community of policy-makers, academics and clinicians will incorporate these issues into their work as a matter of urgency. We also look forward with great anticipation to the updated World Health Organisation Guidelines.

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What The Death of Two Men Teaches Us About Our Blind Spot in the AIDS Response. 08/12/2015

Published at

03 December 2015

Meet Reuben Mokae and Sonwabo Qathula. Two men who both died unnecessarily of AIDS-related illnesses.

They have the same story as hundreds of thousands of men who die of AIDS each year in Africa. And their deaths reminds us of the enduring blind spot in the collective response to HIV and AIDS: our failure to adequately reach men with gender equality education and lifesaving HIV services, especially testing and treatment.

Their deaths also conform to a now predictable pattern. While HIV prevalence is nearly equal between women and men, men make up nearly two-thirds of those who die of AIDS-related deaths globally. Yet, in most of Africa, men make up only one-third of those tested and treated.

Not enough is being done to address this, with consequences for both men and women. And it also severely undermines efforts to reach the goal to end AIDS by 2030.

Reuben’s story

Reuben Mokae was part of the now defunct Men as Partners Network – a coalition of grassroots organisations that educates and supports men to prevent gender-based violence and HIV and AIDS.

A father of three and the son of a priest, Reuben joined the network through a HIV support group he and his wife attended after testing positive in 1998.

He used his own story to help men understand the devastation of gender stereotypes. He spoke proudly of how he rejected them to care for his wife, struggling with AIDS related opportunistic infections. She died in 2003.

His involvement in the program encouraged him to use condoms and other HIV-prevention strategies and understand the need for gender equality. But anti-retrovirals were only started to be available in 2004.

By then it was too late. Reuben was seduced by the South African government’s AIDS denialism at that time. He stopped taking his medication after then-health minister Manto Tshabalala-Msimang described anti-retrovirals as toxic. His health slowly deteriorated until he passed away in June 2005.

Sonwabo’s story

Sonwabo Qathula left home in the Eastern Cape province as a young adult to work on the mines in Johannesburg. He contracted HIV like so many other men forced to live away from their partners for months on end.

He participated in Sonke Gender Justice’s One Man Can Campaign, which mobilises men in rural villages across the Eastern Cape to respond to the interlinked epidemics of gender based violence and HIV and AIDS.

Sonwabo attended a support group for people living with HIV. But typical of these groups and the treatment adherence groups they often evolve into, it had no other men. He struggled to find people to relate to his struggles of living openly with HIV in a society that still stigmatised men who sought health services. He died in 2011.

Like Reuben, he also stopped taking his treatment. He had also stopped attending the support group regularly.

Lessons to be learnt

There are two lessons that can be learnt from Reuben and Sonwabo’s stories.

First, it is possible to get men to recognise the harm rigid gender norms cause for both women and men. Evaluations have shown that programs like the Men as Partners Network and the One Man Can Campaign can reduce men’s violence against women, increase their support for gender equality and improve their use of condoms and other HIV-prevention strategies.

But very few of those programs are being implemented. To stop AIDS, we will have to recommit to rolling such programmes out across Africa and across the world.

Second, Reuben and Sonwabo, like far too many men, fell through the gaps of a healthcare system oriented primarily towards reaching women during their reproductive years. Women access health services and can be tested for HIV during antenatal and well-baby visits. Men, on the other hand, are not often engaged through their partners’ participation. Men use workplaces and other community-based testing services, but these are not widely implemented.

Creating the right environment

When policies and programs are not developed to increase men’s access to and use of HIV services, the outcomes are predictable. Men get sick and die unnecessarily.

The impact is felt by their sexual partners, their families, their communities and the health systems that serve them. When men do not know their HIV status they are less likely to change their sexual practices and they are less likely to use condoms.

They are also less likely to access treatment and they are more likely to need ongoing care and support. This burden is initially borne by women who care for them at home. Later it is public health officials. In addition, patients with low CD4 counts require expensive treatment.

The failure of health services to adequately engage men drastically reduces the effectiveness of the impressive new HIV prevention breakthroughs. If adopted widely they have the potential to break the back of the epidemic. But the success of approaches like treatment as prevention or pre-exposure prophylaxis will be undermined if men are not reached.

In the last ten years, many studies have raised alarms about men’s low involvement in HIV services. Researchers have urged action on two fronts. Challenge the norms that portray seeking health services as unmanly and a sign of weakness. And improve health system policies, programs and service delivery strategies for better HIV services for men.

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Southern Africa: Ending AIDS depends on ending Violence Against Women and Girls. 02/12/2015

Published at genderlink

Written by Lynette Madekunye

01 December 2015



Johannesburg, 1 December: One of the ten targets in the UNAIDS fast track strategy to End AIDS by 2020 released in October is that "90% of women and girls live free from gender inequality and gender-based violence to mitigate risk and impact of HIV".

The same strategy notes that nearly half of new global HIV infections in 2014 were in East and Southern Africa, with the highest burden of new infections being in young women and adolescent girls. In our region adolescent girls acquire HIV infection five to seven years before young men.

UNAIDS has warned that at this rate we will not end AIDS. UNAIDS has therefore called on the world to invest even more energy in the fight against AIDS in the next five years.

On World AIDS Day let us all join the fight to End AIDS in our communities, towns, cities and districts by 2020. Let us begin by making every home and community a No Gender Based Violence zone. Let us teach our children not to perpetrate violence and to say No to violence when it is perpetrated against them. Women, men, boys and girls must all be actively involved if we are to succeed.

The aim is to achieve the three zeros: Zero new infections, Zero AIDS related deaths and Zero discrimination. We must move much faster to the three nineties which are 90 per cent of all people living with HIV tested; 90 per cent of those who know that they are living with HIV on treatment and 90 per cent of those on treatment adhering to the treatment.

While globally the mortality or death rate as a result of HIV has fallen drastically in most age cohorts since the introduction of antiretroviral therapy (ART), the death rate as a result of HIV has continued to rise in adolescents. In Africa AIDS is now the leading cause of death in adolescents. It is the second leading cause of death in adolescents in other parts of the world. There is clearly a need to focus much greater attention on prevention of HIV infection for adolescents and particularly for adolescent girls.

This means that we must all come together to address the root causes of HIV infection in adolescent girls. The world joined forces to do what we believed was impossible - to make it possible for millions of people in very poor parts of the world to access complex treatment.

The first goal was three million people on antiretroviral treatment globally by 2005 (3 by 5). As an international community we met the 15 million people on treatment by 2015 (15 by 15) target nine months ahead of schedule. These achievements are truly remarkable, but treatment alone cannot end AIDS.

We are called now to bring the same passion and energy to the fight to prevent new infections. In Africa the statistics tell us very clearly that we have to prevent new infections in adolescent girls and young women.

The evidence shows that intimate partner violence increases the risks of HIV infection by 50 per cent and that there is a direct link between childhood abuse and HIV infection - both immediately and in later life.

Studies on violence against children in East and Southern Africa show high levels of violence - from just over 20 per cent of girls and 15 per cent of boys in Malawi to over 35% of girls in Swaziland. Globally, one in ten girls or 120 million girls, have experienced forced sexual acts or forced intercourse.

The levels of physical violence against children are much higher - from 40 per cent of girls and just over 50 per cent of boys in Malawi to over 60 per cent of girls and 75 per cent of boys in Zimbabwe and 65 per cent of girls and just over 70% of boys in Kenya.

Violence against children often happens in our homes, schools, places of worship and communities and is often perpetrated by people that are known to and even trusted by the girls and boys. Children who have experienced violence often become perpetrators of violence. They tend to accept this violence as normal and may not resist it or take action to prevent it.

We need especially to address violence in schools where children should spend at least twelve years of their lives. Schools should be places where children learn how to interact with each other to make the world better. However, they are often the opposite - places where children experience bullying from each other and violence or harassment from the adults that should be protecting them.

Learning cannot take place in schools which are not safe. Young girls who stay in school longer have lower levels of HIV infection than those that drop out. Children are more likely to stay in schools which are safe and encourage girls and boys to learn.

We must all come together to urgently address gender based violence against girls and boys and intimate partner violence. To break the cycle of physical and sexual violence against children and intimate partner violence against women, we must make all our communities - rural, urban and peri urban safe for women and children of all ages.

All leaders at every level of society from national to provincial to district to community and in every sector - be it government or traditional or religious - must clearly commit themselves to working with their constituents to making every community and nation a safe place for women and children.

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DREAMS initiative for adolescent girls and young women in South Africa . 27/11/2015

Published at UNAIDS

17 November 2015

Adolescent girls and young women must be empowered to provide the leadership that is needed to reduce new HIV infections in the highest burden countries in eastern and southern Africa. This is the message that Luiz Loures, UNAIDS Deputy Executive Director, shared during the launch of an international initiative in Johannesburg, South Africa, on 17 November that aims to keep adolescent girls and young women free from HIV.

Adolescent girls and young women are at higher risk of HIV infection for a range of biological and socioeconomic reasons, including poverty, gender inequality and limited access to youth-friendly health services. Adolescent girls and young women account for a quarter of new HIV infections in South Africa, according to the Human Sciences Research Council of South Africa. Yet, behind the numbers, there is a vibrant group of people aged 15 to 24 who are eager to get involved in solving problems that affect them and their communities.

Better known as DREAMS, the Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe initiative is supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation and Girl Effect.

DREAMS will be implemented in two provinces and five high-burden districts in South Africa. Its ambitious target is to reduce new HIV infections among young women and girls by 40% over two years in 10 countries across eastern and southern Africa.

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UNAIDS calls on Countries to put The Health and Rights of Women and Girls at the Centre of Efforts to end The AIDS Epidemic by 2030

Published at UNAIDS

25 November 2015

GENEVA, 25 November 2015—On the International Day for the Elimination of Violence against Women, UNAIDS is urging countries to put women and girls at the centre of efforts to end the AIDS epidemic by 2030.

AIDS is the leading cause of death of women of reproductive age (15–49 years) and adolescent girls and young women are most affected by HIV. Every year around 380 000 adolescent girls and young women become newly infected with HIV and in sub-Saharan Africa adolescent girls and young women aged 15–24 years account for one in every four new HIV infections.

“AIDS-related deaths are increasing among adolescents and we are seeing increased violence against young women,” said UNAIDS Executive Director Michel Sidibé. “Our call is to address the root cause—gender inequality, which can result in violence, lack of esteem, growing vulnerability and difficulty for young women and girls to make empowered and informed decisions about their health and well-being.”

In some regions, women who have experienced physical or sexual partner violence are 1.5 times more likely to acquire HIV compared to women who have not. While the experiences of violence faced by women living with HIV mirror those of women generally, living with HIV exposes women and girls to other forms of violence, including forced and coerced sterilization, because of their HIV-positive status.

The heightened vulnerability of women and girls to HIV is intricately linked to the sociocultural, economic and political inequalities they experience. Ending the AIDS epidemic will depend on a social justice agenda that demands equity in education, employment, political representation and access to justice and health, free from violence.  

At the start of the annual 16 Days of Activism against Gender-Based Violence, which is being held under the 2015 theme of “From peace in the home to peace in the world: make education safe for all,” UNAIDS is urging all countries to ensure the engagement and empowerment of women as a top priority to enable women and girls to live in a world free of inequalities and violence.

The newly adopted Sustainable Development Goals, as well as the UNAIDS 2016–2021 Strategy, reflect a collective global commitment to achieve gender equality, eliminate gender-based violence and advance the rights of women and girls, including sexual and reproductive health and rights, and their empowerment. Significantly, they provide a bold blueprint for action. These goals and targets call for true collaboration across sectors and generations to scale up efforts to ensure the safety and empowerment of women and girls everywhere.

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Hidden From View: HIV and Women in Rural South Africa. 21/10/2015

Published at Amnesty International

Over the past two decades the HIV epidemic has had devastating effects on the health and wellbeing of communities in South Africa. More recently, access to life-saving antiretroviral treatment and care through state and non-governmental programmes has expanded remarkably. Both the improved ability of people living with HIV to maintain their health and stronger government leadership have helped reduce social discrimination.

But challenges remain. People living in rural areas still struggle to gain access to the food and services they need to maintain their health because of poverty and because they live in remote areas. In addition, women's ability to protect their health continues to be affected by discriminatory practices, economic marginalization and violence.

Carers in these communities, some of whom are also directly affected by HIV, provide the most marginalized households with emotional support and access to state services. They provide vital and often unpaid support to people living with HIV, helping them to overcome the barriers they face to making their right to health a reality.

The Hidden From View exhibition was developed through an active partnership between Amnesty International and Senzokuhle Community-Based Organisation (CBO) Network. It celebrates the often hidden work of community-based carers in poor rural communities in South Africa.

The voices of the carers in this exhibition come from a particular area of KwaZulu-Natal, the province most affected by the HIV epidemic, where nearly 40 per cent of women attending antenatal clinics are HIV positive. The concerns they express have a resonance across the country however. Their role needs greater recognition and support as South Africa continues to develop its response to the epidemic.

Senzokuhle and Amnesty International collaborated in this initiative also to increase recognition of the importance of community-based care work in supporting people living with HIV. To contribute to wider civil society campaigning, we are urging the government of South Africa to ensure that such care work is valued and resourced. We believe that this will strengthen the state's efforts to meet its obligation to ensure non-discriminatory access to health services. The state must ensure that there is no discrimination in access to health services as part of making the right to health a reality.

The slideshow below provides an abridged version of the photo exhibition that has been successfully shown in two locations in South Africa as part of the 16 Days of Activism against Gender Violence in 2011. The first exhibition in Eshowe, KwaZulu-Natal, was attended by the carers themselves as well as local dignitaries, policy makers and media. The second was held in Soweto and was also attended by local dignitaries, community carers from the Johannesburg area and youth participants. By portraying some of the sombre realities through photographs and testimonies, carers challenged the authorities to tackle the remaining barriers to health for women and the poor in remote communities.


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Sugar Daddies :Whats in it for teens. 21/10/2015

Published at

Written by Shakira Regchand

21 October 2015

Durban - Even where HIV knowledge is high, the benefits of relationships involving young women and “sugar daddies” are seen by the women to outweigh the risks.So says a University of KwaZulu-Natal professor.

Speaking during a panel discussion last week, Professor Beverley Haddad said these relationships were not seen by the parties involved to pose any risk.She and Professor Gerald West, along with Bongi Zengele, a PhD candidate, were part of the discussion at the university’s Pietermaritzburg campus.

Haddad said research among adolescent high school pupils in a rural community in 2010-11 showed that girls aged 15 to 19 got HIV at least five to seven years earlier than their male peers.Although the reason was not fully understood, it was thought to be a complex interplay of biological, socio-behavioural and epidemiological factors.

“A key factor is that young women are engaging in age-disparate sexual relationships.”These relationships were dangerous because there was a decreased use of condoms, earlier age of sexual debut and often coerced or forced sex. This resulted in HIV vulnerability in young women.

Haddad said that sexual intercourse between younger women and older men led to the “anti-sugar daddy” campaign by the provincial government.Such relationships took place in rural areas because of lack of access to education and health services, unemployment and wanting economic benefits to meet subsistence needs such as school fees.

There was also pressure from families to gain access to financial resources through marriage.In urban areas, reasons included material and financial benefits, status among peers and the perception that older men were more caring, less disrespectful and less abusive.Her proposed possible interventions included an extension of social grants, creative community-level interventions and older peers acting as mentors.

Zengele said that when it came to sugar daddy relationships, among the 15-49 age group, HIV prevalence was 23.3%for women, 13.3% for men.


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Putting Women’s and Girls’ Rights at the Centre. 21/10/2015

Published at UNAIDS

October 10 2015

For me, the biggest lesson learned in the AIDS response from the past 15 years is that if we keep neglecting the social dynamics that relate to the epidemic, especially those that pose barriers for women and girls, such as gender-based violence and harmful gender norms, we will keep falling short in tackling the root causes of the epidemic.

HIV is not only a health-related issue, it cuts across almost every aspect of a person’s life and in different ways depending on where they live, how old they are, what gender identity or sexual orientation they have and how much income their households generate. For women, and girls in particular, these dynamics play an important role in terms of the risks and vulnerabilities associated with HIV, including gender-based violence and harmful gender norms, discrimination and oppression. HIV is a matter of social justice.

 In the face of an epidemic entrenched so deeply in social exclusion, violence and injustice, the AIDS response must keep striving for inclusiveness, respect for human rights — including women’s and girls’ rights—and gender equality. To achieve this we need strong political commitment and a cohesive women’s movement.

My greatest hope is that the future holds a world where every woman and girl, everywhere, is free to decide on her own life and is empowered to succeed, free from gender-based violence and harmful gender norms, regardless of her age, gender identity, sexual orientation, work and any other issues that have divided humanity for so long. Only then will we see the end of the AIDS epidemic.


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Older Women: At Risk for HIV Infection. 11/05/2015

Published at the Well Project
6 February 2015

Table of Contents

UNAIDS estimates that over 3.5 million older adults (age 50 and over) are living with HIV (HIV+) worldwide. The proportion of adults who are older and living with HIV has increased in all regions since 2007, and is highest in high-income countries.

In the US, HIV began mostly as a disease of young men. Today, however, the epidemic affects both women and men of all ages, including older women. While 45 or 50 may not seem 'old,' it is often the age currently used by organizations that keep track of health-related statistics (e.g., the US Centers for Disease Control and Prevention, or CDC).

While most new HIV infections are still in younger people, women over 50 are getting HIV at an increasing rate. In addition, many people living with HIV are living longer, healthier lives because of the success of newer HIV drugs. As a result, it is estimated that by 2015, almost half of all people in the US living with HIV will be over 50.

Older Women: An Overlooked Group

Older women are sometimes ignored or overlooked in discussions about HIV prevention and care. It is important that this change, and that older women, their health care providers, and their families understand how the virus can and does impact this group.

  • The number of women over 45 living with HIV in the US has been steadily growing in recent years. According to the CDC, the number of women over 45 living with HIV increased 22 percent from 2006 to 2008, and an additional 26 percent from 2008 to 2011. In 2011, women over 45 represented over half of all women living with HIV (52 percent). In 2012, women over 45 represented over one third of all newly-diagnosed women in the US. It is important to consider that these reported numbers are likely smaller than the real number of women over 45 living with HIV, since many people do not get tested for or diagnosed with HIV even though they may have been HIV+ for several years.
  • Despite the myth that older people do not have sex, many older women are sexually active. One study showed that close to three out of four people aged 57 to 64 had had sex in the last year, as had over half of those aged 65 to 74. Older women can actually be at greater risk for HIV infection during sex than younger women because of thinner vaginal walls and dryness that can cause tears in the vaginal area.
  • Many women over 50 are thinking about dating and becoming sexually active after the end of a long-term relationship or the death of a partner. Women who have been in monogamous relationships for many years and are now becoming sexually active with new partners may not see themselves as at risk for HIV. They may feel uncomfortable discussing sexually transmitted diseases (STDs) or safer sex with their partners or health care provider, and may not know how to protect themselves.
  • Many older women have gone through menopause and therefore do not think about using condoms for birth control. However, condoms can prevent the spread of STDs at any age. For more, see our article, Talking with Your Partner about Condoms.
  • Older HIV+ women are more likely to be invisible and isolated, keeping their disease hidden from friends and family. They are afraid to admit they have HIV because of the stigma.
  • Due to the lack of awareness of HIV in the older population (women in particular), this age group has been left out of educational prevention programs, research, and clinical trials
  • Many older women inject drugs, and are therefore at risk of getting HIV from sharing needles and other drug equipment. The CDC reports that injection drug use is the cause of about 16 percent of new HIV diagnoses in people over 50.
  • Older individuals are not routinely tested for HIV. This occurs in part because health care providers often feel uncomfortable asking older patients about their sexual behaviors. It also occurs because health care providers, like the general public, are often under the misconception that older women are not sexually active. Therefore, when faced with an older patient with flu-like symptoms, many health care providers do not think to test for HIV. This means that older women are often misdiagnosed and/or not diagnosed with the virus until they have reached a more advanced stage of HIV disease.

What To Do?

There are many things older women can do to prevent the spread of HIV and live healthier in their second half of life.

Understand HIV: Knowledge is Power

First, it is important for older women to have correct information about what HIV is and how it is spread (transmitted) from person to person. To learn more, see The Well Project's articles, What Is HIV? and HIV Transmission. If you have heard rumors or stories about HIV, check out our Myths and HIV article to separate fact from fiction.

See the video "HIV and Aging" from the Administration on Aging from the Department of Health and Human Services (DHHS) by clicking the link below.



Age does not protect you from getting or spreading HIV. Practicing safer sex can reduce your risk of getting HIV. So can using clean needles when injecting drugs. For more information, see our articles, Safer Sex and Cleaning Works.

Getting Tested

It is important to prevent new HIV infections in older people by making sure that they understand the need for routine HIV testing and early diagnosis. The CDC now recommends that screening for HIV infection be performed routinely for all patients aged 13 to 64 years in all health-care settings. If you are older than 64, you still need to be tested for HIV if you are sexually active. Additionally, it recommends that all health-care providers encourage patients and their prospective sex partners to be tested for HIV before initiating a new sexual relationship.

If you have been exposed to HIV, no matter what your age, it is important that you get tested for HIV and talk about post-exposure prophylaxis (PEP) with your provider. PEP means taking HIV drugs to prevent HIV after an HIV exposure. PEP needs to be taken within 72 hours of being exposed to HIV and lasts for 28 days.

If you do test positive for HIV, there is no need to give in or give up (please see our article, Did You Just Test Positive?). With a good attitude and a good HIV drug regimen, you may be able to live with HIV well into old age. If you are negative, you can learn what you can do to stay that way. Lastly, knowing your HIV status is an important way to prevent the spread of HIV to others you care about.

Unfortunately, older people are often a forgotten audience for HIV informational programs. We do not usually see the face of an older person or senior citizen on HIV prevention posters. It is important for health care and social service providers to recognize and accept that their aging patients and clients are at risk for HIV. It is also important for providers to ask older patients about their sexual and drug histories.

It is just as important for older women to tell their health care providers about any injection drug use or unsafe sexual experiences, as well as any physical or sexual violence in their lives. Also mention any other events or situations that you think may have put you at risk for HIV, such as getting a tattoo without being sure that the tattoo artist was using sterile disposable needles. Giving your health care provider accurate information is the best way to protect your health and ensure that you get good medical care, even if it feels awkward or uncomfortable to do so.

Older Women Living with HIV

There are several ways in which living and aging with HIV are different compared to aging without HIV infection. Many of the health problems of older people appear to happen earlier and progress faster in people living with HIV. If you are an older HIV+ woman, you may be interested in our articles, Menopause and HIV and Aging and HIV.

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Girl power: rethinking the way we approach HIV/AIDS in girls and young women. 4/5/2015

Published at One World
Written by Cornelia Lluberes
24 April 2015

Photo credit: PEPFAR.

Photo credit: PEPFAR

With over 1,000 new infections each day, young women and adolescent girls are the biggest risk group for HIV infection in the world. Nowhere is this risk greater than sub Saharan Africa, where girls account for 80% of all new infections among adolescents, and HIV/AIDS is the leading cause of death for girls and women age 15-49. Despite these stark numbers, policymakers in the HIV/AIDS community have historically neglected young women, often positioning them as an afterthought. What has resulted, in the words of Global Fund Executive Director Mark Dybul, is a “fundamental failure of adolescent girls and women.”

I recently attended two events on this issue—one hosted by amfAR and the other sponsored by the Center for Strategic and International Studies (CSIS). Admittedly, I was skeptical to attend, afraid to hear a clichéd recycling of phrases about needing to do better. Yet what I uncovered was a refreshingly honest discussion of the complicated nuances of HIV/AIDS in women and girls, as well as demand for more holistic solutions. Here are the five most important themes I heard at the events:

Power Structures

If we hope to eliminate HIV/AIDS in young girls and women, we must seek out new approaches that address the structural drivers that increase female HIV risk, including poverty, violence, a lack of education, and the gendered distribution of power in society. Secured by information access, technology, income, education, social capital, freedom from violence, and a voice, this power infiltrates all levels of society, from government to communities to families to personal relationships.

Too often, women’s access to power is compromised by their vulnerability to physical and sexual violence. Compared to older women, adolescent girls are at a much greater risk– studies in over 80 countries found that 30% of girls age 15-19 have experienced intimate partner violence (IPV), and 25% report that their first sexual experience was involuntary.

In order to lift women from cycles of violence and HIV/AIDS, it is crucial to empower them by fostering and harnessing their social, cognitive, and economic assets. At CSIS, Judith Bruce of the Population Council emphasized the need to provide girls and women with protective means to build upon these assets. Comprised of friends, a mentor, a safety plan, personal identification, a savings plan, and financial literacy, these “toolkits” will enable girls to develop skills, friendships, and social networks that will help protect them from violence and risk of disease.

Women as a Vital Resource

Investing in women in such a way will not only alleviate the risk of HIV/AIDS, but also contribute to broader development goals. As Mark Dybul shared at CSIS, 92% of every dollar invested in women is reinvested back into communities, in contrast to just 42% for men. Just last month, the value of investing in women was similarly stressed in ONE’s Poverty is Sexist: increasing the amount spent on key health interventions for women and children by just $5 per person per year, it reported, could yield a nine-fold return on investment.

Multisectoral Cooperation

At CSIS, U.S. Global AIDS Coordinator Debbie Birx offered an unsettling anecdote, in which an African Minister of Finance told her, “The Minister of Health never talks to me about HIV…is it still a problem?” In many parts of the world, this sort of miscommunication within governments is unfortunately the norm. In order to ensure improved outcomes for women, it will be critical for health ministries to collaborate and engage with other sectors, including finance, justice, women’s affairs, agriculture, and education. Fortifying the link between health and education will be particularly imperative to protect women, as better educated women are more likely to delay marriage, earn better incomes, and have greater decision-maker power in relationships.

Perhaps one of most illustrative examples of multisectoral cooperation in the global health space today is DREAMS, an initiative recently launched by the President’s Emergency Plan for AIDS Relief (PEPFAR) in partnership with the Bill and Melinda Gates Foundation and Nike. With over $200 million in funding, DREAMS aims to use education and increased economic opportunities to lift girls from the burdens of poverty and disease, with the ultimate goal of reducing HIV-incidence in high-burden areas by 40% in three years.

Increased Emphasis on the Science of HIV/AIDS

Better understanding the science of HIV/AIDS is also essential for designing better programs to keep girls healthy. At amfAR , the NIH’s Gina Brown revealed that the female anatomy makes women more susceptible to HIV infection than that of men, as semen can remain in the vagina for a prolonged period of time and the tissue of the vaginal lining contains certain types of cells that HIV can easily enter. For this reason, a female receptive partner’s risk of HIV is almost 13 times greater than that of an intrusive male partner. Likewise, amfAR VP Rowena Johnston explained how estrogen dramatically affects the way in which the HIV virus inhibits human DNA and can yield more serious side-effects to treatment.

A better understanding of the science of HIV/AIDS can help encourage the development of more targeted and innovative therapies for women and girls. At amfAR, Sharon Hillier of the University of Pittsburgh School of Medicine discussed some of these new options, such as pre-exposure prophylaxis (PrEP), vaginal rings, and gel products which have yielded an almost 40% reduction in infection in clinical trials.

Data & Numbers

The final, yet arguably most important, theme was the importance of data as an instrument of both motivation and evaluation for HIV/AIDS-related programs. As shared by Debbie Birx at CSIS, PEPFAR has begun using enhanced data tools to strategically target the geographic areas and populations most in need. Crowning herself a “data diva,” Birx lauded the recent launch of PEPFAR’s Dashboards, an online platform which enables everyone to view and utilize PEPFAR data, optimizing transparency, mutual accountability, and the actionable potential of information. It is only with such accessible data, speakers at both events agreed, that we will obtain the political impetus to invest in women’s health and the analytical capacity to track progress and prove that the investments we are making are worth it.

The girls and young women around the world affected by HIV/AIDS are undoubtedly worth it. Let’s now invest in the data, the scientific research, the multisectoral cooperation, the expanded opportunities, and the more equitable sociopolitical structures to prove it.

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Empowering women is critical to ending the AIDS epidemic. 6/3/2015

Published at UNAIDS
Press Statment
8 March 2015

GENEVA, 8 March 2015—As we celebrate International Women’s Day, world leaders and civil society are gathering in New York to take part in the 59th session of the Commission on the Status of Women. There, they will review the progress made since the adoption 20 years ago of the Beijing Declaration and Platform for Action, which set ambitious targets designed to improve the lives of women around the world. The Platform for Action strived to make sure that women and girls could exercise their freedom and realize their rights to live free from violence, go to school, make decisions and have unrestricted access to quality health care, including to sexual and reproductive health-care services.

In the response to HIV, there have been major advances over the past 20 years and new HIV infections and AIDS-related deaths are continuing to decline. However, in reducing new infections this success has not been shared equally.

In 2013, 64% of new adolescent infections globally were among young women. In sub-Saharan Africa, young women aged 15 to 24 are almost twice as likely to become infected with HIV as their male counterparts. Gender inequalities, poverty, harmful cultural practices and unequal power relations exacerbate women’s vulnerability to HIV, but concerted global commitment and action can reverse this.

Twenty years ago, world leaders recognized that gender inequality was a major barrier to women achieving the highest possible attainable standards of health, and that women had unequal opportunities to protect their health and well-being. The Beijing Declaration and Platform for Action recognized fundamentally that the human rights of women include their right to assume control over matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence. We should all be concerned that 20 years on, the United Nations Secretary-General’s report on the implementation of the Beijing Declaration underscores unacceptably slow progress in many areas, including the persistent denial of sexual and reproductive health and rights.

The core principles of the Beijing Declaration are at the heart of UNAIDS’ commitment to ending the AIDS epidemic. As the world moves towards collectively agreeing global sustainable development goals, we need to reaffirm the commitment that no one is left behind.

UNAIDS has put forward a global Fast-Track Target of reducing HIV infections to less than half a million per year by 2020. Reaching this ambitious target means committing to reducing new infections among women and girls by at least 75% over the next five years. The 90–90–90 treatment targets are also important as AIDS is the leading cause of death globally among women of reproductive age and of adolescent girls in Africa. The 90–90–90 treatment targets are: 90% of people living with HIV knowing their HIV status; 90% of people who know their HIV-positive status receiving treatment; and 90% of people on HIV treatment having a suppressed viral load so their immune system remains strong and they are no longer infectious.

Ensuring that women and girls are empowered to protect themselves from HIV, to make decisions about their own health and to live free of violence, including violence related to their HIV status, will be crucial to ending the AIDS epidemic by 2030.


The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners to maximize results for the AIDS response.

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Women living with HIV: a matter of safety and respect . 24/02/2015

Published at Open Democracy
Written by Bev Wilson
16 February 2015

Last month the results of a global survey on women living with HIV were published. The survey was designed and conducted by women, and commissioned by the World Health Organisation. Will the findings be acted upon? 

In 2014 the World Health Organisation commissioned the largest international survey to date on the sexual and reproductive health and human rights of women living with HIV. The survey was designed, led and conducted by women living with HIV.  Last month the global survey was published: Building A Safe House On Firm Ground

I live in Canada in a small rural setting, and I have been living with HIV for many years. The survey calls for "safety, support and respect for all women at all times".  It is my hope that readers examine the survey in its entirety.

A total of 832 women from 94 countries, aged 15-72, with another 113 women in focus groups from 7 countries took part in the survey. Violeta Ross (Bolivia) expressed how "This consultation means for me, the opportunity to learn from one and other. Women living with HIV are the best positioned for the design of sexual and reproductive health policies".

The single most prominent finding of the survey was how women living with HIV experience high rates of violence, on a continuum throughout the life cycle: 89% of the respondents reported experiencing or fearing gender-based violence, before, during and/or after HIV diagnosis.

Violence was described as physical, psychological and/or financial, with an HIV diagnosis or disclosure acting as a trigger for violence at times. Over 80% of respondents reported experiences of depression, shame and feelings of rejection. Over 75% reported insomnia and difficulty sleeping, self-blame, very low self-esteem, loneliness, body image issues, or anxiety, fear and panic attacks, whether before, or as a direct result of, or after diagnosis.

Poverty ties in with violence, along with gender inequality. Many women with HIV come from diverse backgrounds, such as drug use, sex work, being lesbian or transgender. Women are often in relationships where they do not have the financial means to leave and are reliant on their partners, placing them in an unequal power dynamic and open to further abuse and blackmail.

The survey reveals the way in which the lack of human rights-based approaches to women's services contributes to mental health issues, lack of satisfying sex lives, and lack of sexual and reproductive rights. All women with HIV have the right to achieving their sexual and reproductive rights as a fundamental part of being human. The survey also highlights the importance of women needing to achieve their own rights in all these areas in order for them adequately to support their children and partners – which women with HIV are very much wanting to do.

The report strongly recommends the meaningful involvement of women living with HIV as active participants in all plans and research which affects them. 

As Sophie Strachan of the UNAIDS Dialogue Platform and the Global Coalition of Women and AIDS explained, “The main importance of this consultation is that WHO hear and take up our recommendations, listen to our voices (as experts) to hear the needs of women living with HIV and include peer led support/services in their guidelines. We need gender specific policies to ensure the rights of women in all our diversities are met."

Gender-based violence against women living with HIV is a world-wide phenomenon. In a Canadian context it takes place on a continuum from polite rejections, discrimination and regular experiences of being stigmatized, to more overt forms of violence including physical assault, threats of violence during disclosure of their HIV status or with partners who use the secret of “shame” of their HIV status to control women and keep them from leaving a relationship.

Women living with HIV in Canada often have children and cannot find adequate child care. So they cannot spend time furthering their education and are therefore trapped in a poverty cycle which is often impossible to break. This further exacerbates the potential for abuse and violence.

Indigenous women in Canada represent a small percentage of the overall population, but are over-represented in the number of women living with HIV in Canada, as are women of colour who have emigrated from other regions of the world. Women living with HIV in Canada often live in isolation, keeping their HIV status private for fear of backlash from the community and to protect their children from stigma and discrimination.  Living in isolation leads to decisions to not seek treatment, not seek care and support to deal with stress and anxiety, and not take prescribed medication on a regular basis, if at all.

It may come as a surprise to learn that Canada has one of the highest rates of criminalization of HIV for non-disclosure in the world. This needs to be addressed to alleviate fear and silence about HIV. Canada demands that other countries adhere to basic human rights practices, yet at home we do not. Fortunately we have a strong organization, the Canadian HIV/AIDS Legal Network, which lobbies for de-criminalization of HIV and changes in our government's position on this topic. Criminalization of HIV in fact serves to increase HIV transmission. With the onus on the HIV positive person to disclose their status to sex partners or risk prosecution, individuals assume and expect that everyone living with HIV will disclose, and they rely on this and do not ask questions, do not insist on the use of condoms or any safe sex practices. This causes a false sense of security for people on the dating scene, and indirectly creates a situation where people living with HIV are used as part of screening mechanisms for safe sex practices, with the rationale that a person can rely on prosecution if and when a person does not disclose their status. It places the burden of disclosure on the person living with HIV, and does not emphasize the need for each individual to take responsibility for their own sexual health and well being. Laws will not protect people from contracting HIV, personal responsibity for oneself will. 

Two recent court rulings in 2013 and 2014 against women in Canada for non-disclosure of their HIV status highlight how the law lags far behind science in relation to the virtual impossibility of transmitting HIV if one has an undetectable viral load. There is a critical need to decriminalize HIV; there is also a need for everyone to take responsibility for their own sexual health. 

Services to support women living with HIV in Canada exist in a splintered fashion and vary from province to province.  In Quebec I have had many conversations with women living with HIV, but there seems to be no clear or definitive answers about why women are so reluctant to engage in services. Service providers do not have the solutions around engaging women in services either. From my own point of view I would like to see more concrete and  practical services which will enable us to learn new job skills to integrate back into the work place.

A human rights focus is needed as much in Canada as it is in the so-called “developing” world. The many components on the continuum of violence towards women living with HIV need to be addressed, including financial inequality, need for adequate housing, job security and human rights-based approaches to employment and care.

There is an obvious need for a national cohesive voice for women living with HIV in Canada. What needs to take place here in Canada, as everywhere, is a serious attempt to practice the meaningful involvement of women living with HIV in the full cycle of all aspects of planning, programme implementation and evaluation. We are the experts, and we alone can identify what our needs are and how they can be addressed. This was clearly demonstrated in the Salamander Trust survey, which has produced the most meaningful and authentic results I have read to date.

World Health Organisation (WHO) guidelines now need to be updated to reflect both the findings of the report, and to reflect recent political and biomedical aspects of the HIV response. 

Building A Safe House On Firm Ground.  Principal author, The Salamander Trust, together with ATHENA Network, the Transgender Law Center, the International Community of Women living with AIDS Zimbabwe and Asia-Pacific chapters and GNP+. The survey was commissioned by the World Health Organization.

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SHARE project reduces incidence of intimate partner violence and HIV. 15/01/2015

Published at Avert
13 January 2015

A community project in Uganda involving a combination of different behavioural interventions has been shown to significantly reduce incidence of intimate partner violence (IPV) and HIV among individuals exposed to the interventions. The Safe Homes and Respect for Everyone (SHARE) project used community based interventions to reduce physical and sexual IPV, and reduce HIV incidence in the Rakai District of Uganda – an area characterised by high rates of HIV prevalence and incidence, and relatively high rates of IPV.

The study enrolled 11,448 people from a pre-existing community cohort study of people already receiving a package of HIV prevention and treatment services. Of those eligible, just over half of the respondents were given the standard package of HIV services, including HIV prevention and general health education and access to prevention of mother-to-child transmission (PMTCT) services, among other things. Whilst the other half were given HIV services with the SHARE intervention. The SHARE project included interventions at the community level to change attitudes, social norms and behaviours that contribute to IPV and HIV risk. It also included an intervention to reduce the risk of sexual and physical violence relating to disclosure of HIV status.

The researchers recorded self-reported experience and perpetration of past year physical, emotional and sexual IPV, as well as HIV incidence. They found that the intervention had an impact on past-year physical IPV, sexual IPV and forced sex. Only 12 percent of the respondents in the SHARE intervention self-reported past-year physical violence, compared to 16 percent in the control group. However, the difference in incidence of emotional IPV was not significant. SHARE was also associated with higher rates of HIV disclosure among both men and women. The intervention resulted in a significant reduction in HIV incidence, however after the intervention ended the reduction was not sustained.

The researcher’s remark that with the rapid scaling-up of combination prevention and health strategies focused on promoting gender equality, IPV prevention be made integral part of all HIV prevention, treatment and support services. They state: “The SHARE model is a promising, gender-responsive intervention to reduce both IPV against women and infection with HIV.”

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Gender News 2014

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The Young, Female Face of HIV in East and Southern Africa. 7/11/2014

Published at Inter Press Service
Written by Miriam Gathigah
7 November 2014

 Gender inequalities explain why prevention is failing to contain HIV infection among young women in East and Southern Africa. UNAIDS calls for a major effort to reduce their risk of infection. Credit: Mercedes Sayagues/IPS

Gender inequalities explain why prevention is failing to contain HIV infection among young women in East and Southern Africa. UNAIDS calls for a major effort to reduce their risk of infection. Credit: Mercedes Sayagues/IPS

NAIROBI, Nov 7 2014 (IPS) - Experts are raising alarm that years of HIV interventions throughout Africa have failed to stop infection among young women 15 to 24 years old.

“Prevention is failing for young women,” says Lillian Mworeko, HIV expert with International Community of Women Living with HIV in Eastern Africa, based in Uganda.

The failure of prevention: young women and HIV in East and Southern Africa
  • In Lesotho, HIV prevalence of four percent among adolescent girls rises four-fold by the time they are 24.
  • In Botswana, the number of women newly infected with HIV (6,200 in 2012) has only declined by 14 percent since 2009.
  • The age of consent for marriage is 15 years in Malawi and Tanzania.
  • Nearly half of all girls in Malawi are married by age 19.
  • In South Africa, within the 25- 29 year age group, HIV prevalence among women is 28% and 17% among men (UNFPA)
  • In Tanzania, young women are almost three times more likely to be HIV positive than young men
  • In Malawi, the number of women acquiring HIV has not decreased since 2009, at 29,000 per year.
  • In Tanzania, HIV prevalence jumps from one percent among girls under 17 years old to 17 percent by age 24.
  • In Sub-Saharan Africa, adolescent and young women account for one in four new infections.

Source: UNAIDS


Among women in East and Southern Africa, four out of ten new HIV infections among women aged 15 years and over happen among  those aged 15 to 24, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Worryingly, HIV infection rates among young women are double or triple those of their male peers. In South Africa, the HIV prevalence of 18 percent among women aged 20-24 is three times higher than in men of the same age. 

Equally alarming are surveys showing that fewer than two in ten young women know their HIV status.

Experts attribute this high HIV prevalence to gender inequalities, violence against women, limited access to health care, education and jobs, and health systems that do not address the needs of youth.

Biology does not help. Teenage girls’ immature genital tract is more prone to abrasions during sex, opening entry points for the virus, Dr Milly Muchai told IPS.

Muchai, a reproductive health expert in Kenya, says it is not just sex that drives HIV infections among young women but the age of the male sexual partner.

“The risk increases steadily with male partners aged 20 years and over,” she explains.

Older men are more likely to have HIV than teenage boys. The Kenya AIDS Indicator Survey 2012 shows that male HIV prevalence remains low and stable until the age of 24, when it shoots up significantly.

Due to intergenerational sex, women in this region are acquiring HIV five to seven years earlier than men, says Muchai, because these relationships are characterised by multiple sexual partners and low condom use. In transactional sex, the young woman receiving gifts or money loses power to negotiate safe sex.

But Kenya is not a unique scenario.

Shocking figures

In Swaziland, Lesotho and Botswana, more than one in 10 females aged 15 to 24 are living with HIV, according to UNAIDS.

Dr Gang Sun, UNAIDS country director in Botswana, says that, in spite of the country’s remarkable progress in reduction of new infections and treatment, HIV is still a girls’ and women’s epidemic due to gender inequality and unequal power dynamics.

Among Batswana youth aged 20 to 24 years, HIV infection among women triples that of men, nearly 15 percent compared to 5 percent, he says.

Mary Pat Kieffer, senior director at Elizabeth Glaser Paediatric AIDS Foundation in Malawi, told IPS that as teenage girls become older, the risk of infection rises.

In Swaziland, HIV prevalence is six percent for girls aged 15 to 17 but rises to a whopping 43 percent by age 24.

Source: UNICEF

Source: UNICEF

A package of interventions

Kieffer says that many of the issues – poverty, lack of secondary education, few jobs, rape and intimate partner violence – that underpin the unacceptably high HIV prevalence among young women are bigger than what HIV programs alone can address.

Mworeko observes major gaps in reproductive and sexual health services for young people, when they are neither children nor adults, in the region.

“Whether it is prevention, treatment, care and support services, young people do not have a youth friendly corner,” she says.

Paska Kinuthia, youth officer with UNAIDS in South Africa, told IPS that sexuality education needs to be strengthened in schools across the region.

“The regional average of comprehensive knowledge of HIV and AIDS stands at 41 percent for young men and 33 percent for young women,” he says.

Experts agree there is no one single solution to protect young women and a combination of interventions is needed.

Addressing restrictive laws on the age of consent for HIV testing and for access to sexual and reproductive health services would be a good place to start, experts say.

Promoting gender equality and providing jobs for young people are part of the solution, says Sun.

In Tanzania, HIV infection among girls more than triples between 15-19 and 20-24 years.

This fact, says Allison Jenkins, chief of HIV/AIDS with the United Nations Children’s Fund in Dar es Salaam, underlines “the importance of orienting HIV prevention and economic livelihoods interventions during her transition to adulthood.”

For all these reasons, UNAIDS is calling for “a major movement to protect adolescent girls and young women from HIV infection.”

Edited by: Mercedes Sayagues

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Domestic Violence Affects Women Living with HIV at 2 Times National Rate. 15/10/2014

Published at AIDS United
Author unkown
15 October 2014
Full title: Domestic Violence Affects Women Living with HIV at 2 Times National Rate; Trauma Increases Chances of Becoming Infected and Complicates Treatment. AIDS United hosts congressional briefing to address the intersection of domestic violence and HIV among women.

WASHINGTON, D.C. — Today, more than 1 in 3 women in the United States will experience significant physical or sexual violence in their lives, often perpetrated by current or former intimate partners, according to a survey by the Centers for Disease Control and Prevention. Sadly, the rate of intimate partner violence (IPV) and other trauma is even higher among women living with HIV. According to one meta-analysis published in AIDS and Behavior, among U.S. women living with HIV:

•  55% experience intimate partner violence (IPV) — two times the national rate.
•  61% have been sexually abused — five times the national rate.
•  30% have post-traumatic stress disorder (PTSD) — five times the national rate.

Another study (Psychosomatic Medicine) shows that this heightened level of trauma further complicates HIV treatment and can accelerate the progression of HIV, making women sicker and consequently more likely to transmit HIV to others.

“Clearly, addressing violence and trauma is an essential tool for preventing HIV transmission and helping women living with HIV better engage in care,” said Dr. Vignetta Charles, Ph.D., senior vice president of AIDS United, a nonprofit dedicated to ending the AIDS epidemic in the United States through strategic grant-making, capacity building, formative research and policy. “Women who are exposed to IPV are more likely to engage in behaviors that put them at higher risk for HIV, and they face several physiological and psychosocial factors that also put them at higher risk. In addition, HIV is a risk factor for IPV, often because disclosure of your status may trigger violence.”

At a congressional briefing held Oct. 13, AIDS United urged greater collaboration from all stakeholders—including federal partners and community advocates — to address this critical intersection of women, violence, trauma and HIV. The standing room only briefing was sponsored by AIDS United in cooperation with the Congressional HIV/AIDS Caucus, and co-chaired by U.S. Reps. Barbara Lee, D-Calif., Jim McDermott, D-Wash., and Ileana Ros-Lehtinen, R-Fla.

The briefing, in recognition of Domestic Violence Awareness Month, brought together representatives from more than 35 congressional offices, numerous federal agencies, and many organizations and advocates already involved in HIV issues to discuss this critical intersection and to find areas for future collaboration and partnerships.

“Violence against women doesn’t go away with an HIV diagnosis,” added panelist Naina Khanna, executive director of the Positive Women’s Network USA. “HIV diagnosis may in fact exacerbate violence against women.” In fact, according to a study published in Maternal and Child Health Journal, 45% of women living with HIV have experienced physical abuse as a consequence of disclosing their serostatus.

The briefing follows the Friday, Oct. 10, release of the federal Working Group report on Addressing the Intersection of HIV, Violence against Women, and Gender-Related Health Disparities. The report summarizes progress made by federal partners and community organizations, and it identifies areas for future focus, including scaling up effective interventions to help women who have experienced violence and greater outreach to communities with high rates of HIV infection.

“We applaud the efforts of our federal partners. AIDS United and our community stakeholders are also increasing our efforts. In recognition of Domestic Violence Awareness Month, we hope that this congressional briefing highlights the incredible actions being taken by federal agencies and community organizations and will also inspire congressional leaders to respond to the needs of women at risk for and living with HIV,” summarized Dr. Charles.
# # #

Download our 1-pager on the intersection between women, violence, and HIV here.

Download the briefing presentation here.

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South Africa: Pregnant women and girls continue to die unnecessarily. 9/10/2014

Published at Amnesty International
9 October 2014

Mbali Ndlovu and her sister Zanele (holding her baby) at their homestead in Uthungulu District, KwaZulu-Natal, South Africa, January 2014

Mbali Ndlovu and her sister Zanele (holding her baby) at their homestead in Uthungulu District, KwaZulu-Natal, South Africa, January 2014

© Amnesty International.

Hundreds of pregnant women and girls are dying needlessly in South Africa. In part, this is because they fear their HIV status may be revealed as they access antenatal care services, according to a major report published by Amnesty International today.

Struggle for Maternal Health: Barriers to Antenatal Care in South Africa, details how fears over patient confidentiality and HIV testing, a lack of information and transport problems are contributing to hundreds of maternal deaths every year by acting as barriers to early antenatal care.

“It is unacceptable that pregnant women and girls are continuing to die in South Africa because they fear their HIV status will be revealed, and because of a lack of transport and basic health and sexuality education. This cannot continue,” said Salil Shetty, Amnesty International’s Secretary General.

“The South African government must ensure all departments work together to urgently address all the barriers that place the health of pregnant women and girls at risk.”

South Africa has an unacceptably high rate of maternal mortality. There were 1,560 recorded maternal deaths in 2011 and 1,426 in 2012. More than a third of these deaths were linked to HIV. Experts suggest that 60% of all the deaths were avoidable.

Antenatal care is free in South Africa’s public health system. However, Amnesty International’s research found that many women and girls do not attend clinics until the later stages of their pregnancy because they are given to believe that the HIV test is compulsory. They fear testing and the stigma of being known to be living with HIV. Nearly a quarter of avoidable deaths have been linked to late or no access to antenatal care.

Worryingly, these fears are not without foundation. Amnesty International’s report, based on field research conducted in Mpumalanga and KwaZulu-Natal provinces, contains testimonies from women and girls who say that health care workers inappropriately discuss HIV test results with others.

“The nurses are talking about people and their status”, a woman from KwaZulu-Natal explained.

Amnesty International also found that several clinics it visited use processes for pregnant women and girls living with HIV that disclose their status, including separate queues for antiretroviral medication, different coloured antenatal files and different days for appointments.

“[I]f I go for antiretroviral, my line is that side. All the people in this line they know these people are HIV. That’s why people are afraid to come to the clinic,” one woman in Mpumalanga told Amnesty International.

“During antenatal care, if women come out of the counsellor’s room with two files, then everyone knows they are HIV positive,” said another woman.

Women and girls said they feared discriminatory treatment even from partners and family members as a result of testing positive for HIV and that HIV-related stigma remained a problem in many communities.

“While HIV testing is an important public health intervention it must be done in a manner that respects the rights of women and girls and does not expose them to additional harm. It is deeply worrying that the privacy of pregnant woman and girls is not respected in health facilities. The South African government must take urgent steps to correct this,” said Salil Shetty.

“It is vital that health care workers in South Africa receive additional training on providing quality care that is both free of judgement and stigma and that women and girls accessing sexual and reproductive health services are able to trust that their confidentiality will be respected.”

Lack of information about sexual and reproductive health

Amnesty International’s report also identifies that a lack of information and knowledge about sexual and reproductive health and rights increases risks of unplanned pregnancies and HIV transmission, especially among adolescents. Likewise women and girls are often unaware of the importance of early antenatal checks.

Persistent problems relating to transport

The report also documents the lack of progress made in KwaZulu-Natal and Mpumalanga to ensure that women and girls can physically access health services. Problems persist relating to shortages of public transport and poor road infrastructure. The roads in some areas visited by Amnesty International are of such poor quality that they become impassable when it rains. Even when it is dry, ambulances will not go beyond a certain point on some roads. Amnesty International had documented the same problems in both provinces in a 2008 report.

“The South African government must build better road networks in these rural provinces to guarantee access to healthcare facilities. The government must also ensure that ambulances are always available to transport those who are in need,” said Salil Shetty.

Amnesty International is also calling on the government to:

  • Ensure that all health system procedures uphold patient privacy, particularly for people living with HIV.
  • Improve knowledge about sexual and reproductive health and rights, including through comprehensive sexuality education that involves men and boys.
  • Urgently address the persistent lack of safe, convenient and adequate transport, and the poor condition of transport infrastructure.

Additional information

This report builds on Amnesty International’s 2008 report, ‘I am at the lowest end of all’: Rural women living with HIV face human rights abuses in South Africa, in which the organisation documented gender, economic and social inequalities as barriers to health care for women living with HIV.


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AIDS2014: Young Women and HIV Breakfast Panel. 24/7/2014

Published by YWCA Australia.

Speaking at a YWCA hosted breakfast this Thursday 24 July, and as part of the AIDS2014 Conference, Australia’s Ambassador for Women and Girls Natasha Stott Despoja said it is essential we highlight the issues faced by young HIV positive women.


Sharing the World YWCA’s commitment to ensuring the inclusion of women’s voices in such important dialogue, Stott Despoja will be joined by three other speakers – NORAD (Norwegian Aid) Senior Advisor Anne Skjelmerud, Marvel Spaine of the YWCA in Sierra Leone, and Lalchhuanzuali of the YWCA India.

“As the global community negotiates the priorities beyond the conference, shining a spotlight on the issues affecting young women and HIV is critical,” Ambassador Stott Despoja said. 

At the breakfast, the former Senator and now Chair of the Foundation to Prevent Violence against women and their children will also meet with members of the World YWCA Conference delegation (21 women from 15 countries around the globe), led by Hendrica Okondo, the Global Programme Manager for Sexual and Reproductive Health and Rights (SRHR), and HIV and AIDS, who, through decades of work and experience, knows all too well the huge challenges which lie ahead:

“We know that HIV is the leading cause of death and disease among women of reproductive age worldwide, and young women aged 15 to 24 accounts for 22% of all new infections worldwide. Our goal is to ensure that issues facing women in relation to sexual reproductive health and rights and HIV continue to be a key priority in the global AIDS response,” Ms Okondo said.

Of the 21 members that make up the World YWCA conference delegation (from countries ranging from Kenya, Honduras, Albania, Papua New Guinea, and India, to name just some), many are young women, and many are personally living with HIV. All are working to improve outcomes relating to SRHR and HIV within their communities.

The Conference has provided these delegates with the chance to participate in dialogues about their own experiences and concerns back home. Lalchhuanzuali from YWCA India notes that “In India, young women’s sexual and reproductive rights are undermined. If you are under the age of 18 you can’t get tested without parental approval. That needs to change,” she said. 

Throughout the IAC, World YWCA delegates will be sharing their experiences by tweeting, writing and blogging throughout their time in Australia. To stay up to date, visit our Facebook Page, follow us on Twitter, or visit the World YWCA website and Women Leading Change Blog.

Ambassador Stott Despoja, Hendrika Okondo, Marvel Spaine and “CZ” Lalchhuanzuali will be available to speak to the media at the event. Or contact Sarah Capper on 0432 831 3300432 831 330 or email to arrange an interview outside of the breakfast.

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Putting Women and Girls at the Center of Development. 11/9/2014

Published by Impatient Optimist. Written by

It is well-recognized that gender inequalities exist around the world. Evidence has also mounted showing that the marginalization and neglect of the needs, roles and potential of women and girls are key factors limiting advances in human health and development outcomes for all – women, men, boys and girls. 

Moreover, strong associations have been identified between addressing inequalities and enhancing women and girls’ empowerment and agency, and improved health and development outcomes across sectors ranging from agriculture to family planning and maternal newborn and child health and nutrition. Investing in women’s and girls’ empowerment is a smart investment for overall development as well as a matter of social justice. And many global health organizations are recognizing these facts and acting on them to magnify the impact they are able to achieve.

In this week’s issue of the prestigious magazine Science, Melinda Gates weaves together her personal experience and journey of learning that has resulted in her call for our foundation to address gender issues more intentionally in our work. Drawing from the latest evidence as well as extensive observations and conversations with women in low and middle countries, she recognizes that it is a matter of social justice when women – half of the world’s population – are marginalized, lacking in agency and voice, and unable to share in control of income or assets or influence decisions in their homes and communities. 

Addressing gender inequalities is the right thing to do, as a fundamental right of women and girls to equal opportunity to live a healthy and productive life. She also argues that gender equality is key for achieving impact across multiple health and development sectors. It is the smart thing to do too.

It’s important to measure the impact of health and development programs, not only on sector outcomes such as modern contraceptive prevalence rate, prevalence of stunting, immunization rates, or access to digital financial services, but also on gender outcomes – things such as equitable decision-making power, personal safety, mobility, and equitable interpersonal relations in the home which promote women’s individual dignity and safety. These outcomes reflect empowerment of women and girls not only as a fundamentally important end in and of themselves. They also are the ingredients that enable women and girls to be engines of change in their communities, thus creating a virtuous cycle of enhanced gender equality and women’s empowerment and improved health and economic and social development for households, communities and nations. Thus, to ignore gender in health and development programming – to be blind to gender inequalities and therefore to do nothing intentional to address them – leads to missed opportunities to enhance the lives and potential of women and girls as well as men and boys, and leads to lost health and development impact as well. It’s poor stewardship. What’s more, being gender blind or unintentional is a roll of the dice. Impact of health and development programs may be lost, but women and girls could also be harmed. The potential for gender-based violence is real, for example, when women begin to gain access to financial resources through increased agricultural productivity, or family planning services, or, as highlighted by Malala, when girls gain access to education. 

As a learning organization, Melinda Gates calls upon our programs to move beyond the existing evidence to help accelerate discovery of how to most effectively and intentionally identify and address gender inequalities. We also need to do more to develop better measures of the impact of interventions to enhance women’s and girls’ empowerment and agency. Combining interventions in health and development (for example, improved supply chain logistics for contraceptives) with interventions that address an existing gender gap (e.g., facilitating conversations between men and women, leading to more collaborative decision-making about family planning) might lead to enhanced sector outcomes (for example increased modern contraceptive prevalence rate) and gender outcomes.  These actions may improve outcomes in other sectors too, for example improved child nutritional status. Aspects of agency such as equitable influence and control over assets and decision-making power have positive associations with outcomes across multiple sectors. Many organizations have worked for years to identify effective ways to address gender inequalities and empower women and girls. It’s time for the foundation to join forces with these important and ground-breaking efforts, be more intentional about addressing gender inequalities, and scale up approaches that we know work, in context-relevant ways, within existing health and development programs.

Additional research and rigorous evaluation are also needed to investigate how addressing gender inequalities and promoting women’s and girls’ empowerment will enhance the ability to achieve impact in different sectors, and how sector and gender outcomes can influence each other. Furthermore, there is a gap in our knowledge of the existence and measurement of gender inequalities and the cost-effectiveness of approaches to address them in different contexts.  Innovation, integration and better data and measurement are needed in this space. We don’t have all the answers today but we have a plan and call to action to get smarter about each of these issues over time.

This is the journey of learning that Melinda Gates is calling the foundation to, and CEO Sue Desmond-Hellmann will be leading going forward. This is what we intend to deliver. Many of our program teams have been working intentionally to address gender issues, but we recognize that we can do more. We will be making additional investments in the near future, for example in a new Grand Challenge that will be launched in early October. It’s an exciting evolution in our organization. Most importantly, it’s a change that will position us to more effectively engage with partner organizations working to enable women and girls around the globe to improve their well-being and that of their families, societies and our world.  

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Campaigners Welcome 'Milestone' Agreement at UN Gender Equality Talks 25/04/14

The Commission on the Status of Women agrees to stand-alone equality goal in post-2015 targets and issues strong language against violence

MDG : Commission on the Status of Women (CSW) opens at the UN Headquarters
Delegates meet at UN headquarters in New York for the 2014 Commission on the Status of Women. Photograph: Ryan Brown/UN Women

UN Member states have agreed that gender equality and women's rights must be prioritised in future discussions on what should be included in the next set of sustainable development goals.

After two weeks of negotiations in New York, the Commission on the Status of Women (CSW) ended in the early hours of Saturday morning with an agreement that called for the acceleration of progress towards achieving the millennium development goals, and confirming the need for a stand-alone goal on gender equality and women's empowerment in the set of international targets that will be introduced once they expire in 2015. The agreement also said gender equality must underpin all other goals.

Campaigners welcomed the strong language in the outcome document, which had been fiercely fought over by delegates in the final days of negotiations.

The document will now be used to push for a stand-alone goal and the mainstreaming of gender equality into the sustainable development goals, which are currently being negotiated by the UN open working group.

There were concerns that some important references to women's rights would be removed or watered down in the document when the Vatican, which has a seat on the UN as a non-member permanent observer state, began pushing for significant changes to the text.

During the discussions, the Holy See reiterated that it could not support the use of condoms and that abstinence was the only measure to prevent HIV.

The African bloc of countries had also been agitating to include a sovereignty clause in the document. Such a clause would have allowed governments to ignore the recommendations that could interfere with their own traditions and practices. This clause was withdrawn.

The inclusion of the stand-alone gender goal also proved contentious and the final decision to include it was by no means unanimous.

But there is general agreement that this year's CSW did produce a strong outcome. The document makes specific references to uphold women's sexual and reproductive health and rights; there was agreement to eliminate all harmful practices, including child marriage and female genital mutilation, which, significantly, would in future not be referred to as "cutting". There were also explicit references made to a woman's right to access abortion services and for the development of sex education programmes for young people. And there was strong language around violence against women and girls. The document called for the elimination and prevention of violence and for the prosecution of perpetrators.

The document also called on governments to address discriminatory social practices, laws and beliefs that undermine gender equality.

Efforts to weaken calls for increased funding for women's organisations were successfully resisted.

Phumzile Mlambo-Ngcuka, the executive director of UN Women, said the agreement represented "a milestone toward a transformative global development agenda that puts the empowerment of women and girls at its centre".

In a statement to the commission, Mlambo-Ngcuka said:
"The safety, human rights and empowerment of women are pivotal in the post-2015 debate. UN Women is encouraged by the call of a large number of member states for a stand-alone sustainable development goal that addresses these issues. This will require political will, backed up by commensurate resources. As the commission rightly points out, funding in support of gender equality and women's empowerment remains inadequate. Investments in women and girls will have to be significantly stepped up. As member states underline, this will have a multiplier effect on sustained economic growth.

"We know that equality for women means progress for all. Through the development of a comprehensive roadmap for the future, we have the opportunity to realize this premise and promise. The 58th session of the Commission on the Status of Women has given important impetus to making equality between men and women a reality."

Françoise Girard, president of the International Women's Health Coalition (IWHC), said: "By committing and investing in efforts to promote gender equality, governments can unleash the power of half the world's population to build a more peaceful, just, and sustainable planet.

"Agreement to a standalone goal on gender equality was not a foregone conclusion here, given the small, but very vocal conservative opposition to women's rights. It's a major step forward to have the commission agree to it."

Shannon Kowalski, director of advocacy and policy at the IWHC, added: "The commitments made by governments at the UN are an important victory for women and girls. We have achieved what we came to do, against great odds and the determined attempts by the Holy See and a few conservative countries to once again turn back the clock on women's rights."

Antonia Kirkland, legal advisor at Equality Now, said: "We are heartened that UN member states were able to reach consensus at the Commission on the Status of Women and endorsed the idea that gender equality, women's rights and women's empowerment must be addressed in any post-2015 development framework following the expiration of the millennium development goals.

"Throughout the process there has been broad agreement that freedom from violence against women and girls, as well as the elimination of child marriage and female genital mutilation must be targets within such a framework. Equality Now believes sex discriminatory laws, including those that actually promote violence against women and girls, must be repealed as soon as possible to really change harmful practices and social norms."

As expected, any mention of sexual orientation was removed from the final text, as was an acknowledgment of the diversity of families. Governments, including Norway and Argentina, said they would continue to push for these issues at CSW next year.

Amanda Keifer, international policy analyst at Advocates for Youth, said CSW had reflected the increasingly polarising environment in which sexual rights, particularly the rights of lesbian, gay, bisexual and transgender people, are discussed.

"A number of governments have championed the most controversial issues in an incredibly hostile environment. But we have also seen hateful and regressive rhetoric from governments and far-right civil society organisations.

"There is no reason that sexual and reproductive health and rights should be so controversial in 2014."

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Gender-based Violence and HIV: Addressing Twin Epidemics 25/04/14

By Hajjarah Nagadya for Women Deliver

Hajjarah Nagadya is a young woman living with HIV and a mother of one. She is a member of the International Community of Women Living with HIV in Eastern Africa, as well as the UNAIDS Dialogue Platform for Women Living with HIV.

Governments, NGOs and activists are currently gathered in New York for the 58th Session on the Commission on the Status of Women (CSW), which I am attending as a representative of the Link Up project. As a young woman living with HIV, I want to make sure that the issues that really affect women living with HIV are addressed.

Gender based violence (GBV) is a key driver of HIV transmission in sub-Saharan Africa, where approximately 61% of people living with HIV are women. Women have become the face of HIV in the region, and GBV is a major factor fuelling this. Violence of all forms, particularly affecting vulnerable groups most at risk of the HIV epidemic  including young women, sex workers, and transgender women, must be addressed.

I have attended meetings and events at the CSW where GBV has been firmly on the agenda – and the links to HIV recognised. GBV is a huge issue. Nearly a third of women have experienced physical or sexual violence from an intimate partner, and almost 40% of all the murders of women in the world are committed by partners.

Violence takes many forms, and occurs in many places. Women living with HIV experience violence in their homes, in society and in health facilities – where they experience judgments, stigma and even forced or coerced sterilization. In some cases women are not attended to while giving birth because of their HIV status, leading to increased number of maternal deaths. In many African countries women have no ownership of property, have no say about their bodies and do not attain the education they need – this is structural violence against women.

Women living with HIV are more vulnerable to violence, and violence makes women more vulnerable to HIV. Women who have experienced violence are up to three times more like to have HIV than those who have not. Violence also has a major impact on the health of women. Women who experience intimate partner violence are 16% more likely to have a low birth weight baby, 1.5 times more likely to acquire HIV and 1.5 times more likely to acquire syphilis infections, chlamydia and gonorrhea.

Young women under the age of 24 are at particular risk. Country statistics compiled by the United Nations show that younger women in Africa are more likely to experience physical or sexual violence than older women, generally from an intimate partner.

Human rights declarations including the Universal Declaration on Human Rights, re-affirmed in multiple international conventions and regional agreements, tell us that all human beings have the right to bodily integrity and to be free from violence. Yet women continue to be victims of violence both in their homes, in hospital and other settings.

I was so shocked to hear that in this CSW 2014, there are still countries that are not in support of sexual rights, on the grounds that it is linked to immorality. We need all rights for all women, if we are to make progress on ending GBV.

Laws that restrict rights or criminalize people are also violence by another name. I was privileged to present at an event co-hosted by the AIDS Legal Network, the ATHENA Network, the International Community of Women Living with HIV and AIDS (ICW) and Link Up partners among others, alongside other women living with HIV, where we discussed criminalization in Africa. The discussion included the many different forms of criminalization and how this links to violence, for example laws criminalizing homosexuality, such as the new law in Uganda, which perpetuate institutional violence.

To end gender-based violence, our governments need to come together, especially at this time when the post-2015 development agenda is being discussed, to push for an acceleration in gender equality and equity and empowerment of women and girls. It is imperative that they collectively address the structural drivers of HIV and inequity and eliminate violence against women and girls and other rights violations, in support of social justice.

Prevention strategies need to address the unequal power between men and women, and norms and practices that put women at a higher risk of exposure to HIV. There is a need to integrate HIV and sexual and reproductive health and rights programmes to meet the needs of women in all our diversity, including from key populations or most at risk groups.

Governments must invest in the capabilities of young women to engage meaningfully in public policy, and ensure all young people’s access to comprehensive sexuality education and services to make informed choices, and prevent HIV and sexually transmitted infections, unwanted pregnancies and sexual violence.

Policies and programs that address issues of violence should be fully monitored and women living with HIV should be at the centre stage of their implementation. Women need to be involved in all decisions on issues that impact on them and be fully engaged in all stages right from planning, implementation, monitoring and evaluation of programs that address their issues.


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Samuel’s Story: Hope after being Raped and Contracting HIV. 11/4/2014

  Country South Sudan


Samuel John, 19, from Yambio, South Sudan, contracted HIV after he was raped by an older woman who sold him alcohol.

“Every evening my father used to send me to buy alcohol for him from a lady. She always cracked funny jokes,” Samuel said. “One day my father sent me a bit late, around 9pm. When I got there she told me to go to her room and she followed me. She asked me to sleep with her. I refused but she forced me and promised to hurt or kill me. Because she was older and had more power, she got hold of my genitals and did what she wanted, telling me not to tell anyone.

“I went home feeling bad. I didn’t inform my dad although he asked why I had taken so long. I didn’t answer because she had threatened to kill me. After about four months she passed away and soon after I started to fall sick. I was taken to the hospital in Nzara county where I was tested for HIV and the result was negative.

“However the sickness was persistent and so one of my friends advised me to go to the Young Men’s Christian Association (YMCA) in Yambio to test for the disease again. This time I was found to be HIV positive and I had no option but to tell my parents. Lots of bad words were thrown at me and the whole family hated me.”

The family’s response to Samuel’s rape

Samuel, who is one of 12 children, told his mother Christine about the rape three months after the incident. It shocked the whole family because they knew the woman was living with HIV and they wondered how she could do that to anyone.

Christine said: “We were disappointed but when Samuel’s father threatened to disown our son I felt so bad I tried all I could do within my reach to make him understand that this wasn’t the end of the road for our son.”

Because of the lack of support from his father, Samuel did not attend education for one year and couldn’t get basic things he needed like the rest of his family members. But after several appeals from Samuel’s mother and other family friends finally his father accepted to take care of him.

Supporting young people living with HIV

Phoebe Josephate, Yambio county inspector of gender and social welfare, said cases like Samuel’s are common in Western Equatoria State. Although Samuel’s case did not reach them in time, Josephate said they could have taken the case before the directorate of children at the state ministry before the woman died.

Josephate called upon parents to avoid sending their children for errands at night as it is not safe. “If such cases of rape happen you should at least tell the authorities concerned such that the law can take its full course,” she added.

According to YMCA director Justin Omar Kirima, the YMCA in Yambio now has more than 30 young people living with HIV registered with them, both boys and girls, who are responding well to counselling and support.

He gave the example of a young girl who went to the YMCA for an HIV test and, when she found out she was positive, went home to her father who took her to the police. A friend of the girl alerted the YMCA who went to the police station where she was in custody for being HIV positive. After lengthy discussions between her father and the elders, he accepted her back at home, although he remained reluctant to continue providing for her.

“We need more young people to join the club in order to freely discuss issues concerning their lives and to find solutions to the stigma and discrimination that exist in the community,” said Kirima.

Samuel’s advice

Samuel now attends the club for young people living with HIV at the YMCA. They are supported with some small things like soap and sugar every Friday. This is to encourage them with the activities around the YMCA, where they can get support and to help them feel that they have a place in society.

Samuel is now in the second year of secondary school despite skipping studies for one year due to the stigma he experienced. His dream is to go to university and study business administration, he said: “I know my dreams can come into reality if only some well-wisher one day will help me pursue my studies.

“I have to give my sincere thanks to the YMCA for what they have done for me in life after I discovered that I was positive. Because of their counselling I want to assure everybody that HIV is not what they are thinking.

“My advice to my friends and to all those reading this is to continue to protect yourselves.  People living with HIV should not remain shy but rather should go and seek treatment because this disease can kill if you don’t get treatment and follow the doctors’ advice.”

Read more stories about stigma and human rights

Image: Samuel John standing by a tree
© Joseph Nashion

Posted by Mulaison Galli

I am 25 years a South Sudanese national, an upcoming journalist, radio presenter and a writer.

I love writing about political, social and health related issues and things that affect the youth and the community around me.

Read full profile and posts >


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Study reveals widespread violence against women in EU. 5/3/2013


BRUSSELS - In the world’s largest study of its kind, the EU agency for fundamental rights (FRA) found that one in three women in the European Union have experienced physical and/or sexual violence since the age of 15.

The results of the study, published on Wednesday (5 March), reveal widespread abuse of women throughout every member state.

“The enormity of the problem is proof that violence against women does not just impact a few women only – it impacts on society every day,” said FRA director Morten Kjaerum.

The Vienna-based agency interviewed 42,000 women. The interviews were conducted face-to-face in a private setting and by women only.

They were asked to describe their experiences of physical, sexual, and psychological violence since the age of 15 and in the past 12 months. Standardised questions on domestic violence, stalking, and sexual harassment both online and offline were also asked.

The survey found 22 percent have experienced physical and/or sexual violence by a partner.

“The figures are somewhat higher in the Scandinavian countries,” Joanna Goodey, head of the freedoms and justice department at FRA, told reporters in Brussels.

Goodey said there are a number of factors that could explain the higher Nordic figures.

She noted that women in Scandinavian societies are more easily able to talk about what is happening to them. Aggressive gender equality campaigns in Scandinavia also mean women occupy roles once reserved for men, she said.

The study found, for instance, that 75 percent of women in qualified professions or top management jobs have been sexually harassed.

“Women in highly qualified top positions may also be confronted with settings which are not traditionally female so they may experience more abuse as they climb up the ladder,” said Goodey.

Almost one in 10 women who have experienced sexual violence by a non-partner, indicate that more than one perpetrator was involved in the most serious incident.

Five percent of all women have been raped.

Children are not immune from the abuse. Thirty-three percent have childhood experiences of physical or sexual violence at the hands of an adult.

Twelve percent were sexually assaulted as children, of which half were from men they did not know.

“For certain children, they were experiencing more than one type of abuse, so we only counted if they experience multiple experiences only once,” said Goodey.

At over 50 percent, Estonia and Finland, top the list for any physical, sexual or psychological violence against girls. At 15 percent, Cyprus is the lowest followed by Slovenia at 16 percent.

Young women are also more likely to be harassed or stalked sexually online.

Over half of all women have experienced some form of sexual harassment. Thirty-percent said the perpetrator was a boss, colleague or customer.

Most do not report the abuse to the police.

“Overwhelmingly, what we see is that the majority of women are visiting a doctor or health care centre or other health care provider or a hospital,” said Goodey.

The study says the scale of physical and sexual violence experienced by women requires for renewed policy attention.

It calls for targeted prevention and awareness raising campaigns for both men and women and suggests member states review their legislation to ensure it is in line with EU law and Council of Europe conventions.

“We have laws in place, we have gender equality laws for a number of decades but are they working in practice?”, asked Goodey.

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UNAIDS and the Global Fund Express Deep Concern About the Impact of a New Law Affecting the AIDS Response and Human Rights of LGBT People in Nigeria - 21 Jan 2014

The Global Forum on MSM & HIV published the following article:

The new law could prevent access to essential HIV services for LGBT people who may be at high risk of HIV infection, undermining the success of thePresidential Comprehensive Response Plan for HIV/AIDS which was launched by President Goodluck Jonathan less than a year ago.
The health, development and human rights implications of the new law are potentially far-reaching. Homosexuality is already criminalized in Nigeria. The new law further criminalizes LGBT people, organizations and activities. The law states, “A person who registers, operates or participates in gay clubs, societies and organisation, or directly or indirectly makes public show of same sex amorous relationship in Nigeria commits an offence and is liable to conviction to a term of 10 years imprisonment.” The law also criminalizes any individuals or group of people who support “the registration, operation and sustenance of gay clubs, societies and organisations, processions or meetings in Nigeria.” The conviction is also 10 years imprisonment.
Nigeria has the second largest HIV epidemic globally––in 2012, there were an estimated 3.4 million people living with HIV in Nigeria. In 2010, national HIV prevalence in Nigeria was estimated at 4% among the general population and 17% among men who have sex with men. 
The provisions of the law could lead to increased homophobia, discrimination, denial of HIV services and violence based on real or perceived sexual orientation and gender identity. It could also be used against organizations working to provide HIV prevention and treatment services to LGBT people.
In the 2011 United Nations Political Declaration on HIV/AIDS, all UN Member States committed to removing legal barriers and passing laws to protect populations vulnerable to HIV.
UNAIDS and the Global Fund call for an urgent review of the constitutionality of the law in light of the serious public health and human rights implications and urge Nigeria to put comprehensive measures in place to protect the ongoing delivery of HIV services to LGBT people in Nigeria without fear of arrest or other reprisals. UNAIDS and the Global Fund will continue to work with the Nigerian authorities and civil society organizations to ensure safe access to HIV services for all people in Nigeria.
UNAIDS and the Global Fund urge all governments to protect the human rights of lesbian, gay, bisexual and transgender people, through repealing criminal laws against adult consensual same sex sexual conduct; implementing laws to protect them from violence and discrimination; promoting campaigns that address homophobia and transphobia; and ensuring that adequate health services are provided to address their needs.
UNAIDS | Sophie Barton-Knott | tel. +41 22 791 1697 |
Global Fund | Ibon Villelabeitia | tel. +41 79 292 5426 |

View original article here

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Gender News 2013

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Why Don't Women Report Their Attackers? 20/12/2013

A new study finds that only seven percent of women worldwide report gender-based violence against them.

The Daily Beast



Jorge Silva/Reuters

A new study finds that only seven percent of women worldwide report gender-based violence against them.

If the term “silent epidemic” has ever meant anything when describing gender-based violence, a new study from the American Journal of Epidemiology suggests that is the only designation to properly describe the current nature of this global problem.

The study, led by Tia Palermo, an assistant professor of Preventative Medicine in the program of Public Health at Stony Brook University, aimed to quantify the magnitude of underreporting of gender-based violence like domestic abuse or sexual assault. Palermo and her two co-authors, Amber Peterman, an assistant research professor of Public Policy at the University of North Carolina at Chapel Hill, and Jennifer Bleck, a PhD student in the Department of Community and Family Health at the University of South Florida, found that, on average, just seven percent of women who experienced violence ever reported to a formal source such as a doctor, the justice system, or a social service provider. In 20 of the 24 countries they analyzed, most women told no one at all.

This study comes on the heels of a report published in the magazine Science earlier this year that found one in three women globally in 2010 experienced violence at the hands of an intimate partner.

Peterman said she was especially struck that the reporting rates were so low even with the recent progress made in research, advocacy and publicity about the prevalence and harmful consequences of gender-based violence. She mentioned the uproar in India one year ago after the brutal sexual assault and murder of a 23-year old New Delhi woman traveling home on a bus as well as more recent cases receiving extensive media attention in Kenya and elsewhere.

“That’s really kind of a powerful look at the hidden nature of this still,” she said, “with all the advocacy, with all the advances that have been made in the last couple of years.”

While experts agree that, for those working in the field, this information is not surprising, the study’s value cannot be overlooked, for it demonstrates through high-quality research how vastly underreported this crime is. The numbers are compelling, and they lay bare not only how many victims continue to suffer in silence and obscurity, but also the inadequacy of many of the systems meant to protect women from such violence.

“It challenges the current investment or the current strategy that has been used globally in terms of focusing on trying to reform formal institutional responses to domestic violence,” said Lori Heise, a senior lecturer at the London School of Hygiene and Tropical Medicine. “While clearly that’s important, I think we are really missing the boat.”

Instead, Heise thinks resources should be recalibrated to also focus on the first responders.

“The first responders are basically friends and family members,” said Heise, an expert on intimate partner violence and a member of the core research team of the World Health Organization’s Multi-Country Study on Women’s Health and Domestic Violence, published in 2005. Palermo’s new study shows that informal reports of this sort dwarfed those that women made to authorities.

“What you see is that if women reach out to anyone for help, that’s where they go. And that is consistent across all of the countries in the world.”It is especially the case in low-income, underdeveloped, or fragile states “where the formal institutions don’t work for anyone,” she said, “much less for abused women.”

To gather their findings, the authors compared data from developing nations that participated in the U.S.-funded Demographic and Health Surveys between 2000-2011. The survey, conducted roughly every five years, asks similar questions worldwide about gender-based violence and whether respondents sought any help. This allowed the researches to reliably compare responses from almost 94,000 women aged 15-49 who experienced gender-based violence in Latin America and the Caribbean, India and East Asia, Central Asia and Eastern Europe, and Africa. They discovered that, depending on the country and region, data from health systems or police reports may underestimate the extent of these sorts of crimes by as much as 11- to 128-fold.

The report is unique, Palermo said, because it is among the few peer-reviewed studies to evaluate reporting and disclosure rates and it covers more countries than previous analyses.The report also attempts to tease out factors among women that might predict whether they disclose violence or not.

The authors found that older women, those who were formerly married and those living in urban areas, tended to report at higher rates than younger, currently or never married, and rural-dwelling women.

Mary Ellsberg, director of the Global Women's Institute and a professor of Global Health at George Washington University, said that the report alludes to what she has found to be the main predictor of disclosure: that it is the severity of violence that most determines whether or not women seek help when they are abused.

“You don’t go to the police until it is a life or death matter, really” she said.“When you think you are literally trying to save your life and the lives of your children.”

That is often because formal sources like the police or medical providers can be unsupportive and insensitive to women who come to them for help, experts say. This may explain the extremely low reporting rates in India, lowest of all the countries compared, where less than one percent of women came forward to report violence to any formal source.

“Women don’t trust the formal sector,” said Ravi Verma, director of the Asia Regional Office in New Delhi of the D.C.-based International Center for Research on Women. “The police system is deeply entrenched into the same notions of patriarchy and gender inequitable perspectives and women don’t feel comfortable that they will be heard or their report will be taken in the right spirit.”

Embarrassment, fear, a belief that disclosure was pointless, and the notion that women must endure violence because it is a normal part of life, were among the reasons the authors found for women’s decision not to report. Dr. Claudia Garcia-Moreno, the lead specialist for Gender Rights and Gender-based Violence in the Department of Reproductive Health and Research at the World Health Organization, said that changing attitudes and norms around this type of violence is essential.

“I think that acceptance of this as a normal thing, which we found in our study both among the men but also the women themselves, that it’s OK for a man to beat his wife if she didn’t do ‘x’ or ‘y’ or she didn’t have the food ready,” she said, referring to the WHO Multi-Country study, “I think that’s a really, really important thing to address.”

Like campaigns to get people to stop smoking or drinking and driving, Moreno said efforts to change violent behaviors against women will require more than one solution. At the WHO, she said they are especially focused on health systems and recently released a set of guidelines for practitioners to better respond to victims of gender-based violence.

Palermo and her co-authors found the highest formal reporting rates in Colombia (26 percent), Bolivia, (nearly 16 percent), and Tanzania (also almost 16 percent). The highest regional average was in Latin America and the Caribbean at just under 14 percent.

While still low, these higher rates of disclosure in Latin American likely stem from the efforts of the women’s movement there to raise awareness among the public and governments that violence against women is a serious problem, said Ellsberg, who lived and worked in Nicaragua for 20 years. This, in turn, has led to more laws and programs to address the issue than in many other parts of the world, although implementation remains weak, she said.

Informal reporting rates to family and friends were highest in the Ukraine, at about 60 percent, and Zambia, at just under 50 percent. Still, globally an average of less than 37 percent of women even reported to these sources.

The authors recommend that next steps should include efforts to end impunity for perpetrators; making gender-based violence, including in intimate relationships, a criminal offense; reducing stigma for victims; and establishing one-stop centers for survivors to receive legal, medical and social services.

Going forward, Peterman said researchers should focus on which interventions prevent violence against women from occurring in the first place.

“We’ve done a good job now at bringing out the prevalence and incidence and a lot of the health and social and economic impacts that violence has had on women and communities and men,” she said. “But we are really kind of at the beginning of the research on understanding which interventions are most promising."

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Violence against Women. 31/10/2013

Author: Megan DePutter - Life 


Megan DePutter says Violence against women is a significant risk factor for HIV, and not only in the ways you might think.


Violence against women

The month of November marks Woman Abuse Prevention month, with November 25th set as the International Day for the Elimination of Violence Against Women.

Violence against women is a significant risk factor for HIV, and not only in the ways you might think. Obviously, women are unable to prevent unwanted sex or demand condom use in instances of sexual assault. And sexual assault can lead to abrasions or tears in the body that can increase the likelihood of transmission. But this is only part of the picture. 

Economic and other forms of power imbalances can prevent women from being able to negotiate safer sex or even bring up the subject of HIV. Gender norms and rape culture that promote sexual aggressiveness among men or contribute to a sense of entitlement to women’s bodies, can make it very difficult for women to negotiate or insist on the kind of sex they want, insist on condom use, or insist on no sex at all. 

Decisions about condom usage are also impacted by gender norms that may be associated with age, culture, or religious beliefs. For example, many young women in my community have reported to community service providers that boys do not want to wear condoms. They complain that they do not like them, or that they do not fit properly. It is all well and good to promote messages like “no glove, no love,” but if a girl or woman wants to continue the relationship, obtain love, financial or other kinds of support, avoid violence, or simply – gasp – have sex, she may agree to have unprotected sex even if she doesn’t want to. In many instances, women or girls are put at risk to HIV, not only through overt forms of physical violence and sexual assault, but through systems that support ideology that endorses male ownership of women’s bodies and sexuality.  

Because women are at once sexualized and vilified for being sexual, women and girls may be reluctant to speak openly about their risks to health care providers, fearing that they be judged as promiscuous.   Not unrelated to this is the fact that only 10% of sexual assaults are reported in Canada. In addition to many other reasons why this is terribly unsettling, this statistic is also important because it means that women who experience sexual assaults are not accessing post-exposure prophylaxis (PEP).

Of course, reporting a sexual assault does not mean that a woman will necessarily be provided with PEP; there are unclear guidelines around administering PEP for a non-occupational exposure and it’s really up to the health care practitioner, who may be unaware or uncomfortable in prescribing PEP. But, given that there are so many barriers and reasons why women do not report sexual assaults, many women who are sexually assaulted by default will not be given the option to use PEP, even in high risk scenarios.

For women living with HIV, stigma can be used as a tool for manipulation. Abusive partners may threaten to disclose their partner’s status – to children, friends, family, employers, or the law. And let’s not forget how the criminalization of HIV non-disclosure affects women who are marginalized or experience violence.For example, if you have seen the film, “Positive Women: Exposing Injustice”, you will recall that in 2005, D.C. was convicted in trial for aggravated sexual assault and sexual assault for failing to disclose her HIV status the first time she had sex with a partner who was physically abusive; for his assaults, the abusive partner received an absolute discharge.

Unfortunately, violence is also a precursor to future experiences of violence, and women who experience violence may also experience other risk-taking behaviours. We know, for example, that the experience of trauma is often present among people who use drugs.

These are just some of the ways in which violence against women intersects with HIV.  As part of the WHAI initiative (Women’s HIV & AIDS Initiative) in Ontario, many of us are working collaboratively with the Violence Against Women and Domestic Violence / Sexual Assault sectors. But this is an issue that should not only be delegated to the WHAI workers.  I fear that sometimes in our efforts to put special focus on certain at-risk populations, we forget that we need to work together in a collaborative and cross-sectoral way to see systemic change.  Violence against women is not a woman’s issue. It is a human issue. I sometimes get tired of hearing myself bleat, over and over again, that women’s rights are human rights, and that we are not a niche group; we represent more than half of the population and more than a quarter of new HIV infections in Ontario. Furthermore, violence against women is most often perpetrated by men; how can this issue be solved by women alone?

In the summer of 2012, we worked with Guelph Little Theatre in their production of the Laramie Project. My goal was to help the audience make the links between overt acts of violence and “socially-acceptable” forms of homophobia that contributed to a climate in which a violent hate crime could occur. I feel we need to do the same with violence against women, by addressing issues around rape culture and other gender norms that contribute to violence against women as well as more subtle forms of inequality when it comes to sexual decision making.

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Malawi President Banda Calls for Partnership in Addressing HIV-Aids Among Girls, Women. 31/10/2013

By Yamikani Yapuwa

Blantyre — President Dr. Joyce Banda has said there is need for stronger partnerships to champion the cause for greater attention to the vulnerability of women and girls to HIV/AIDS in the SADC region.

Dr. Banda made the remarks on Thursday at Sanjika Palace where she had an audience with delegates from the High Level Task Force for Women, Girls, Gender Equality and HIV for Eastern and Southern Africa saying there is need to keep advancing the struggle for the empowerment of women and girls as a strategy to defeat HIV and AIDS.

The President said as much as Africa is making strides in fighting the HIV/AIDS pandemic, the gender and HIV narrative does not appear to change.

"HIV still bears the face of a woman, with almost 60 percent of people living with HIV being women. Among young girls, the rates of infections are 3 to 6 times higher than in young boys and among young people living with HIV in the Sub Saharan region, a staggering 72 percent of them are young women'" said Banda.

The Malawi leader emphasised that education and economic empowerment is the only way that women and girls will only be able to make the choice to stop the cycle of abuse in their everyday lives acknowledging that there are no enough linkages being made outside of the health and HIV sectors to address the deep rooted vulnerability of women and girls.

"There is a link between incomes, gender based violence and HIV/AIDS so it is time we educate more girls and helped women become financially independent so that they can make informed decisions about their lives," explained Banda.

The President also urged women to take the lead in dealing with issue of HIV/AIDS, Gender Based Violence thereby showing their seriousness in tackling them.

"Experience has taught us that if we as women do not push our agenda, no one else will. Therefore as much as these issues of eliminating HIV and AIDS, eliminating violence against women, eliminating maternal deaths, protection of the girl child, are the responsibility of both men and women.

"I think the burden is still on us as women leaders to demand accountability on these issues," she said President Banda added: "As such Africa needs to continue to open spaces for more progressive women to get into leadership positions. We need morewomen leaders to drive the women's agenda, and work for the betterment of all women."

She cited her appointment of women in the positions of Chief Justice, Chief Secretary to the government, Solicitor General, Director of Law Commission and the appointment of nine women Cabinet Ministers as a stepping stone in promoting women into decision making positions.

The High Level Taskforce for Women, Girls, Gender equality and HIV in Eastern and Southern Africa comprises ministers, National AIDS Council (NAC) directors, four Regional UN Directors, Civil Society and women living with HIV was officially launched in December 2011 at the 16th International Conference on AIDS and STI's in Africa (ICASA).

It aims at engaging in high-level political advocacy in support of accelerated country actions and monitoring the implementation of the draft Windhoek declaration for women, girls, gender equality and HIV

The High Level Task Force for Women, Girls, Gender Equality and HIV for Eastern and Southern Africa delegates are in the country to help review efforts being done by Malawi in confronting the challenges of gender inequality and HIV/AIDS.

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Linking HIV and Women's Human Rights 30/10/2013

Women living with and affected by HIV often suffer stigma and discrimination, along with egregious violations such as coercive sterilization. Gender-based violence (GBV), meanwhile, puts women at increased risk of contracting HIV: One South African study found that one in every eight new infections in young women is the result of GBV.  Writes Petra Lanz & Susana Fried of UNDP

The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), adopted in 1979 by the UN General Assembly, is unequivocal on women’s rights to equality and health. It sets out specific measures States should adopt to advance gender equality in all areas, including the elimination of sex- and gender-based discrimination in the context of HIV.

Examples of how gender inequality exacerbates HIV risk vary widely and span the globe. They include inadequate or non-existent legal and property rights; child marriages; higher dropout rates; denial of life-saving health care; and intimate partner violence.

Globally, HIV is still the leading cause of death of women of reproductive age  and contributes to at least 20 percent of maternal deaths. Every minute, another young woman is infected with HIV, according to UNAIDS (PDF).

We have CEDAW, with its accountability mechanism, and abundant data and research on our side. How then, do we move from laws to action? As Jacinta Nyachae, Executive Director of Kenya’s AIDS Law Project says, we have enabling laws, but women often cannot make use of them.

As part of an unprecedented global, public consultation on what citizens around the world believe should succeed the anti-poverty Millennium Development Goals (MDGs) after their target date in 2015, one HIV-positive woman in Papua New Guinea shared a story highlighting the complexities surrounding HIV, violence, rule of law, gender and policy.

The woman, a young mother, has a long walk to an urban medical centre to receive antiretroviral HIV treatment. But rising crime and insecurity, and the women’s fear of being raped or attacked, often kept her at home and away from her treatment, threatening her own health and the well-being of her children.

Women worldwide make similar calculations every day, and face choices no one should have to make. New global development goals should aim for a world in which they never do — protecting women and girls from violence and HIV is a good place to start.

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WCC’s 60-year Journey for Gender Justice Continues. 29/10/2013


Participants from across the ecumenical membership of the WCC gathered from 28 to 29 October for a Women and Men’s Pre-assembly programme preceding the WCC 10th Assembly in Busan, Republic of Korea. The WCC has had a long tradition and commitment to gender justice and advocacy for a just community of women and men in church and society, a commitment which began at the first WCC assembly in 1948.

The current year marks 60 years since the establishment of the WCC programme on Women in Church and Society. This programme provides an opportunity for women representing different Christian traditions, regions and age groups an opportunity to share their visions so they may contribute to society, ecumenical movement and the search for Christian unity.

For the first time in Busan, the pre-assembly gathering of women also included participation of men to reflect on the contribution and role of men towards building a just community of women and men in the church and society. The event provided a platform for shared dialogue between women and men on issues of gender justice.

The Women and Men’s Pre-assembly event began with 60th anniversary celebrations. The men joined celebrations of the work of women including Bishop Barbel von Wartenberg Potter from Germany, who served as director of WCC’s Programme for Women in Church and Society from 1983 to 1986; and Dr Aruna Gnanadason from the Church of South India, programme executive for Women in Church and Society, 1991 to 2011. Gnanadason was present at the celebrations and participated in the two-day conversations.

The celebrations continued with a vibrant welcome from Korean and other Asian assembly participants. This also provided an opportunity for an introduction to the Korean culture along with the global company of women and men gathered from across the world.

The women in pre-assembly reflected on the assembly theme “God of life, lead us to justice and peace”. They acknowledged the realities of many communities that are life-denying to women including the stories of sexual violence, abuse and rape of women as a weapon of war in the Congo and the demolition of homes and its corresponding trauma for women and children in Palestine.

Reflecting on women’s journeys

The women at the event also shared experiences of injustice in church and society, which included denial of ordination for women in church ministry and human trafficking. Many women wept at the stories of human trafficking and abuse of women and girls. It is reported that human trafficking for the purpose of sexual slavery and forced labour represents estimated 32 billion US dollars per year in an industry that enslaves more than 30 million women, men and children each year.

A key session during the women’s conversations included a presentation by the Rev. Dr Elaine Neuenfeldt of the Luther World Federation on “Identifying and dismantling patriarchy and other systems of oppression for women”. She pointed out that in order to transform systems of oppression and achieve gender justice there is a need for clear processes, strategies and policies that promote and encourage the equal participation of women and not simply events for gender justice.

A resounding theme of the conversations among the women has been the call for the recognition that “all women’s issues are community issues and community issues are women’s issues”. Rev Dr. Jennifer Leath of the Africa Methodist Episcopal Church and Yale Divinity School invited consideration for a broader dialogue on issues of gender that will create opportunities for women to dialogue with the other assembly participants such as youth, indigenous peoples and persons with disabilities.

Male participants in their pre-assembly space gathered for an open conversation on masculinities, justice and its connection to gender justice. Victor Kaonga of Trans World Radio in Malawi summarized men’s conversations as an in-depth reflection about the role men play in the advocacy for gender justice. He indicated that the men celebrated achievements of women in their gender justice journey that encouraged men to acknowledge the social structures and privileges of patriarchy to maintain the status quo for women especially in the church. The men also had an opportunity to share their real life experiences and journeys as men and the development of positive masculinity.

The Women and Men’s Pre-assembly provided an inclusive space for dialogue and sharing of conversations between women and men as they journey together in the building of a just community of women and men.

The commitment to gender justice will continue during the WCC assembly, where participants will be encouraged to wear black and support “Thursday in Black” campaign. Through this simple gesture, participants are invited to be part of a global movement urging an end to violence against women. “Thursdays in Black”, according to Dr Fulata Mbano-Moyo, WCC programme executive for Women in Church and Society, is a “united global expression of the desire for safe communities where we can all walk safely without fear of being raped, shot at, beaten up, verbally abused and discriminated against due to one’s gender or sexual orientation.”

Events leading up to WCC assembly focus on justice and peace (WCC news release of 29 October 2013)

WCC programme on Women in Church and Society

High resolution photos can be requested via


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Woman's S. Africa trek after rape is marker for 'Thursdays in Black'. 16/10/2013


Women in bridal gowns protest against domestic violence during an annual march through the Washington Heights neighborhood, in New York September 26, 2013. Every year women wear bridal gowns and men in tuxedos to commemorate Gladys Ricart, who was shot to death in 1999 by a former abusive boyfriend on her wedding day.Photo: REUTERS / Joshua Lott

South African Charlene Lau has begun a 1,400 kilometer (870 mile) walk from Africa's southern tip in Cape Town to Johannesburg to promote awareness of what women suffer when raped.

What happened to Lau and women like her is one the reasons the World Council of Churches is reviving a campaign against sexual and gender-based violence, called "Thursdays in Black."

"Thursdays in Black" began in the 1980s as an opportunity for churches and ecumenical initiatives to stand with women affected by sexual and gender-based violence. 

Lau was raped not once, but three times - by her father as a child, gang raped at 14 and then again at 26.

 Now she wants to engage communities in her trek through South Africa and raise awareness about sexual violence along the way in her country which has a very high incidence of rape.

"I really wanted to encourage other survivors to own their healing process, and to take back their power, to take back their lives. I also wanted to speak to families in South Africa and to encourage them to start having this conversation in their families," Lau told eNews Channel Africa when starting her walk Sunday. The WCC campaign gained support through the "Women in Black" campaign, an initiative of women in support of Serbian and Croatian women affected by sexual assault during the Balkan war in the 1990s. 

Fulata Moyo, WCC program executive for Women in Church and Society, wearing black on a Thursday, demanding an end to violence against women. Photo taken October 2013.Photo. WCC

Through this initiative, Serbian women called people to join them in speaking against the use of rape as a weapon of war.

"Thursdays in Black is a united global expression of the desire for safe communities where we can all walk safely without fear of being raped, shot at, beaten up, verbally abused and discriminated against due to one's gender or sexual orientation," Dr. Fulata Mbano-Moyo, World Council of Churches program executive for Women in Church and Society said in a statement. 

"Through this campaign we want to accompany our sisters, who bear the scars of violence, invisible and visible, in Syria, Palestine and Israel, Egypt, the Democratic Republic of Congo, Pakistan and the whole world, where women's bodies remain a battlefield, whether in armed conflict or so-called 'peaceful' situations." 

The World Council of Churches said in the statement that the "Thursdays in Black" campaign began as a form of peaceful protest against rape and violence. 

The history of "Thursdays in Black" also links to the Mothers of the Plaza de Mayo, a movement of mothers who protested the "disappeared", those killed during the political violence in Argentina during the 1970s and 1980s.

The mothers donned black sashes and walked the Plazo de Mayo in Buenos Aires each Thursday in protest against the responsible authorities.

"Thursdays in Black" encourages participates around the world to wear black in solidarity with women suffering from gender-based violence.

The "Thursdays in Black" campaign is supported and observed in South Africa by the Diakonia Council of Churches and the Christian AIDS Bureau of Southern Africa (CABSA), ecumenical partners of the World Council of Churches' project Ecumenical HIV and AIDS Initiative in Africa (EHAIA) and the International Network of Religious Leaders Living with or Personally Affected by HIV or AIDS (INERELA+).

Working alongside the World Council of Churches to revive "Thursdays in Black" are CABSA, We Will Speak Out Coalition, the Lutheran World Federation, the Fellowship of the Least Coin, the United Methodist Women and the World YMCA, among others.

The emphasis is pertinent to the theme of the WCC's upcoming assembly: "God of life, lead us to justice and peace". 

On October 31, during the once ever seven years meeting of the WCC's highest governing body in Busan, South Korea, its assembly, participants will be encouraged to wear black.

Through this gesture, participants are invited to be part of a global movement urging an end to violence against women.

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One in 10 Young Americans Has Committed Sexual Violence 10/10/2013

Nearly one in ten young Americans has committed an act of sexual violence, a new study in the journal JAMA Pediatrics reports. Of the 1,058 teenagers and young adults, ages 14 to 21, who participated in the online study, 8 percent reported that they had kissed, touched, or “made someone else do something sexual” when they “knew the person did not want to.” Three percent of teens verbally coerced a victim into sex; 3 percent attempted to physically force them into sex; 2 percent perpetrated a completed rape.

Writes of Slate


It’s long been apparent that teenagers face an elevated risk for sexual abuse. One 1998 study found that 12 percent of high school girls and 5 percent of boys have been sexually abused; a 1997 study found that girls ages 16 to 19 are “four times more likely than the general population to be victims of rape, attempted rape, or sexual assault." But this new report sheds light on the demographics, tactics, and attitudes of young sex offenders. One finding in particular stands out: The prototypical teen sexual abuser is a white male from a higher-income family.

Here’s what else the study found:

Demographics: Most perpetrators committed their first act of sexual violence at age 16. Boys are more likely to coerce or force others into sex than girls are (though girls offend, too). White kids and higher-income kids are slightly more likely to rape than their peers. Eighty percent of victims were girls; 18 percent were boys; 5 percent were transgender.

Pornography use: Teens who had watched porn were more likely to be perpetrators, but the discrepancy was “almost entirely explained by whether the material was violent in nature.” Teens who had seen non-violent pornography were equally likely to have committed sexual violence as teens who had seen none, but those who had watched material that “depicted one person hurting another person while doing something sexual” were more likely to be offenders (the study doesn't address causality).

Relationships: In every case, the victim was known to the perpetrator. Fifty-two percent met their victim at school. Three out of four perpetrators targeted a “boyfriend or girlfriend.” Two percent met online.

Tactics: Thirty-two percent of perpetrators argued or pressured another person into sex; 63 percent guilted them into it; 5 percent threatened physical force, and 8 percent used it. Fifteen percent employed alcohol.

Consequences: In 66 percent of cases, “no one found out” about the incident, and the perpetrator faced no consequences. Twenty-nine percent of perpetrators were found out, but were not punished. Eleven percent “got in trouble with their parents.” Just 2 percent—one perpetrator found by the study—was arrested. Seven percent of offenders said they felt “not at all responsible” for the sexual violence; 35 percent felt “completely” responsible; 48 percent felt “somewhat” responsible. Fifty percent felt that their victim was “completely” responsible. (Yes, the overlap confuses us as well.)

The study challenges several popular assumptions about teen sexual violence. Girls can be abusers, and boys can be victims. The study's authors suggest that in light of the findings on race and income, healthcare professionals "assess and perhaps challenge our assumptions about sexual violence as an ill solely conscripted to underprivileged populations." And given the significant proportion of crimes that were discovered but not reported—and the percentage of parents who took care of punishment in their own homes—the study speaks to the opportunity for peers, educators, and caretakers to take action when they discover that a young person in their lives has victimized another. The low percentage of punishment and the high percentage of perpetrators who blame their victims is not a heartening mix.



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SAfAIDS Launches Zero Tolerance to Homophobia Campaign 04/10/2013

SAfAIDS Media Desk:

Over 40 African Leaders from Malawi, South Africa, Zambia and Zimbabwe are gathered in Johannesburg for The Regional Leadership Indaba aimed at championing the fight against homophobia. Running with the theme “Leadership is protecting ALL: Protecting ALL is Leadership”, witnessed leaders from the religious, political and cultural spectrums engaging in dialogues for change and protection of “ALL” including LGBTI community.

Rev Gift Mpho Moerane, of the South Africa Council of Churches set the tone of the two days workshop by his thought provoking remarks. In his address, the Reverend highlighted the importance of involving religious leaders and churches in the fight against discrimination and the violations of human rights. “Leaders should come together to pressure governments to act against discrimination. Violation of human rights should be part of the government agenda. As leaders you need to act as the voices of the voiceless ones” said Rev Moerane. He emphasised the importance of leaders working together to help curb the rise of discrimination of people for no reason.

The two day indaba comes at a time when Africa is facing a widespread epidemic of violence against the LGBTI communities and is serving as a perfect vehicle to educate the various leaders on LGBTI issues and their role in fighting homophobia.

The launch of the Leadership is protecting ALL Indaba marks an important time in Africa. “We enforce the concept of Ubuntu, which emphasises a mutual respect amongst people. Today we pledge to speak out against any form of discrimination, stigma against LGBTI persons. Most importantly we pledge to take care of one another”, said SAfAIDS Executive Director, Mrs Lois Chingandu. The lack of understanding often causes discrimination and stigmatization. It is therefore the duty of everyone here to deconstruct the notions around homosexuality and clarify that same sex relationships are not rooted in their sexual function; It is not something new homosexuality can be traced back in time, added Mrs Chingandu.

In his address SAfAIDS Head of Regional Programmes, Mr Ngoni Chibukire acknowledged the primary goals of the conference which aims to increase respect for human rights of the LGBTI persons through; addressing key drivers of homophobia among leaders in Africa. “The end goal of the Leadership Indaba is to get leaders and the media to speak out on abuse and challenge the wave to criminalize LGBTI people “said Mr Chibukire.

Professors Rothney Tshaka and Leon Roets of the University of South Africa; UNISA provided insights into Sexual Rights and the workplace. Key themes identified include: Sexual Rights as leverage for Social Justice towards LGBTI wellbeing in workplace, organisations and community. In their presentation, they highlighted the importance of treating people equally, with dignity and fairness. The benefit of this will be felt by society at large. Social justice is about giving people what is due.

“In a workshop like this LGBTI should participate so that they can talk to us  “Never plan with people that plan for people” said Leon Roets of UNISA. Meetings like this are important in influencing change of laws; we need them to help create visibility and a voice for the voiceless ones. If the leaders can be educated on issues of LGBTI they will help educate their communities to embrace homosexuality as a natural trait. It is a part of who one is like their race, it is not something you can change or choose” added Professor Roets.

Speakers also touched on Gender Based Violence (GBV), transforming gender (addressed from myopic discussion), unequal power structures in society, sexual abuse and culture of lawlessness (covering of LGBTI and other minorities).

The launch of the Movement for Rock Leadership Champions and the “Zero Tolerance for Homophobia” Campaign in Africa emphasized the need to develop interventions that are evidence based. Foster dialogues and also educate leaders on the matters relating to the LGBTI.

SAfAIDS Media Desk

Email: reg[at]

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WCRC Supports The Camaign Of The UN To Stop Violence Against Women. 04/10/2013

WCRC Supports The Camaign Of The UN To Stop Violence Against Women.

STOP violence against womensay-no-unite

In support of the upcoming International Day of the Girl Child (11 October), this Orange Day, the UNiTE campaign will highlight ‘Safe Schools for Girls’.

The UN Secretary-General’s UNiTE campaign to end violence against women and girls has declared the 25th day of the month as “Orange Day”. This month the focus is on Safe schools for girls. Lets unite to end violence against women!

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Efforts to Prevent HIV Must Focus on Gender Equity. 26/9/2013

Ward Cates and Nirupama Sista

The latest figures on HIV infections, as reported this week by the Joint United Nations Programme on HIV/AIDS (UNAIDS), revealed an impressive 33 percent reduction in new infections among adults and children since 2001. To continue down the road to success, future efforts must address the gender inequities that contribute to the disproportionate impact of HIV and AIDS on women and girls.

More than half of the 35 million people living with HIV are women. In sub-Saharan Africa, almost 60 percent of people living with HIV are women. Young women between ages 15 to 24 are at highest risk of and most vulnerable to HIV infection. Closer to home, black women in the United States remain at high risk for HIV infection, and HIV-related illness is now one of the leading causes of death among black women between ages 25 to 34.

Gender inequity is a key driver of the epidemic, making women more vulnerable to HIV in many ways.

Financial dependence. When women are the primary and unpaid caregivers of their families, they are financially dependent on men and often must accept situations and behavior that put them at risk for HIV. In much of the world educating girls remains a low priority, which adds to financial dependence.

Violence against women and girls. Women and girls are routinely victims of sexual coercion and violence. Some girls are forced into marriage at a young age, often to men who are much older. Even older women fear or experience violence and lack the ability to abstain from sex or negotiate safe sexual practices.

Lack of access to services. Many women do not have access to preventive health services or control of their reproductive health and rights. Unplanned pregnancies increase a woman's burden of care and support for the family. Once infected with HIV, women face even greater stigma, isolation and persecution, which affect access to treatment. Women may transmit the virus to their infants, continuing the spread of HIV and perpetuating a vicious cycle.

What can be done to reverse this situation? The short answer is that HIV prevention efforts need to target women and girls and specifically address the inequities they face. It is critical that interventions not only meet women's needs, but also receive adequate funding. Even today, many young women are not aware of their risks for HIV infection, much less the ways risks can be reduced. Therefore effective prevention programs must be multi-pronged and should include education, safe sex negotiation, life-skills building and job training for women and young girls.

Beyond equipping women and girls with affordable products, such as female condoms, we need more scientific breakthroughs in women-controlled prevention methods, such as topical microbicide gels and rings. New oral or injectable prophylactic agents that prevent HIV infection are in the works and could prove promising.

Educating girls is critical to empowering them and reducing gender inequities. Educated women are more likely to negotiate safe sex and prevent pregnancy. They are also more likely to be financially independent. We must educate communities, and especially young men, about gender sensitivity and the negative effects of violence against women and girls. Women who experience sexual violence should be counseled so they can avert long-term consequences. Stereotypical notions of masculinity and femininity and harmful myths that lead to destructive behaviors affecting women's safety and health must be dispelled. We must encourage and mentor girls and women to be leaders in their communities.

If we are going to see any real and lasting progress in combatting HIV and AIDS, we must make addressing gender inequity a top priority.

Ward Cates, Jr., M.D., M.P.H., is President Emeritus with FHI 360

Nirupama Sista, M.S. PhD is the Director of the Leadership and Operations Center for the HIV Prevention Trials Network at FHI 360

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Understanding Gender-Based Violence Perpetration to Create a Safer Future for Women and Girls 19/09/2013

 Original Text Published in: The Lancet Global Health, Early Online Publication, 10 September 2013 doi:10.1016/S2214-109X(13)70085-8

Authours: Michele R Decker a, Elizabeth Miller c, Samantha Illangasekare a, Jay G Silverman d

Worldwide, one in three women experience gender-based violence,1 which imparts physical, mental, and sexual health morbidities. It also causes mortality—more than a third of homicides of women are attributable to male partners.2 These data justifiably create global outrage, accentuated by horrific recent high-profile cases, including the brutal gang rape of a student in New Delhi, and the attempted assassination of Pakistani student and education activist Malala Yousafzai. However, mounting of an effective, evidence-based, sustainable response to gender-based violence has proven elusive, partly because of the paucity of data for the population that we need to understand the most: the perpetrators of gender-based violence. Most research into such violence focuses on victimisation, which provides invaluable insight into survivors' experiences, risk factors, and needs for support. However, to put a stop to this global pandemic demands a fundamental understanding, and modification, of the behaviour of gender-based violence perpetrators. Population-based data for men's violence perpetration and its root causes are scarce and are mostly limited to Africa.3, 4 Analyses of the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific presented in The Lancet Global Health5, 6 represent a major advancement in that they describe the epidemiology of perpetration of the main forms of gender-based violence—intimate partner violence and non-partner rape—in a large and generalisable sample from the world's most populous region. Such violence perpetration, including rape by multiple perpetrators, was prevalent, with 25—80% of the men studied perpetrating physical, sexual, or both types of intimate partner violence, and 3—27% committing single perpetrator non-partner rape. The findings offer much-needed direction for prevention and intervention.
Targeting of interventions is essential. More than half of non-partner rape perpetrators first did so as adolescents,6 which affirms that young people are a crucial target population for prevention of rape. The finding that gender-based violence perpetration was associated with other key global health issues (eg, substance use and depression)5, 6 suggests the potential usefulness of integrated interventions. Childhood trauma and witnessing of gender-based violence were also influential factors,5, 6 which supports the idea that those exposed to violence during youth should be prioritised for prevention and interventions.
Importantly, as reported in other settings,7—9 perpetration of both intimate partner violence and non-partner rape was linked closely to sexual risk behaviour (eg, having several sexual partners), supporting the suggestion that these behaviours were informed by underlying norms supportive of men's sexual entitlement and dominance in sexual decision-making. As is the case in more generalised HIV epidemic settings, the concurrence of gender-based violence perpetration and sexual risk behaviour hold significant implications for sexually transmitted infections and HIV.8 Clear value exists in integrated interventions that address both gender-based violence and sexually transmitted infections and HIV. Moving forward, anal rape perpetration is also crucial to this risk constellation in view of the HIV transmission efficiency of anal intercourse, especially when forced, and emerging evidence of its links with gender-based violence.10
Also crucial, and consistent with previous research,3 are the effects of gender-inequitable attitudes and sexual entitlement on gender-based violence perpetration. Sustained reductions in gender-based violence perpetration need transformation of culturally and socially reinforced norms that promote and maintain gender inequities. These norms, which are expressed by individuals and informed by, maintained, and codified at the social or structural level, effectively create a culture in which male perpetration of gender-based violence is tolerated at best and expected at worst. Such individual attitudes and social norms need to be addressed within an evidence-based approach to reduce gender-based violence.11 In other low-income and middle-income settings, sexual health interventions targeting gender equity and relationship dynamics led to promising reductions in men's perpetration of,12 and women's experiences of, intimate partner violence.13 Youth-oriented programmes, such as Coaching Boys Into Men, also address gender norms, with promising results including increased equitable attitudes14 and reduced self-reported gender-based violence perpetration.15 This intervention evidence base both shows the mutability of gender-based violence and the attitudes that enable it, and provides a basis for interventions that can be adapted for other geocultural settings.
Gender transformative policy and cultural reforms are also crucial to change prevailing norms and customs that devalue women and girls. Implementation and enforcement of non-discriminatory policies and practices that require gender equity in inheritance, property rights, education, and civil liberties, and that otherwise reduce women's social and economic reliance on men, are imperative. The 2010 launch of UN Women indicates a building worldwide momentum to ensure that these goals become reality. Without such reforms, successful and sustained modification of the individual, family, and community norms that enable gender-based violence perpetration is unlikely.
With one in three women affected by gender-based violence,1 support services remain essential and should not be supplanted by prevention of perpetration. Instead, national and international gender-based violence responses should be simultaneously committed to perpetration prevention and accountability, and to survivor support. Moreover, findings of heterogeneity of patterns and predictors of gender-based violence across settings support the need for local tailoring in collaboration with community practitioners and stakeholders.
Without effective reduction of male gender-based violence perpetration, women's health, wellbeing, and safety will continue to suffer worldwide. The findings from this multi-country study5, 6 provide local, national, and international policymakers with the evidence base and mandate to create meaningful and sustainable reforms. The challenge now is to turn evidence into action, to create a safer future for the next generation of women and girls.
We declare that we have no conflicts of interest.




1 WHO. Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: World Health Organization, 2013.
2 Stockl H, Devries K, Rotstein A, et al. The global prevalence of intimate partner homicide: a systematic review. Lancet 2013. published online June 19.
3 Jewkes R, Sikweyiya Y, Morrell R, Dunkle K. Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study. PLoS One 2011; 6: e29590. CrossRef | PubMed
4 Tsai AC, Leiter K, Heisler M, et al. Prevalence and correlates of forced sex perpetration and victimization in Botswana and Swaziland. Am J Public Health 2011; 101: 1068-1074. CrossRef | PubMed
5 Fulu E, Jewkes R, Roselli T, et al. Prevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific. Lancet Global Health 2013. published online Sept 10.
6 Jewkes R, Fulu E, Roselli T, et al. Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific. Lancet Global Health 2013. published online Sept 10.
7 Jewkes R, Nduna M, Jama Shai N, Dunkle K. Prospective study of rape perpetration by young South African men: incidence & risk factors. PLoS One 2012; 7: e38210. PubMed
8 Dunkle KL, Jewkes RK, Nduna M, et al. Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa. AIDS 2006; 20: 2107-2114. PubMed
9 Decker MR, Seage GR, Hemenway D, et al. Intimate partner violence functions as both a risk marker and risk factor for women's HIV infection: findings from Indian husband-wife dyads. J Acquir Immune Defic Syndr 2009; 51: 593-600. CrossRef | PubMed
10 Madhivanan P, Krupp K, Reingold A. Correlates of intimate partner physical violence among young reproductive age women in Mysore, India. Asia Pac J Public Health 201110.1177/1010539511426474. published online Dec 20. PubMed
11 WHO. Promoting gender equality to prevent violence against women. Geneva: World Health Organization, 2009.
12 Jewkes R, Nduna M, Levin J, et al. Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ 2008; 337: a506. CrossRef | PubMed
13 Kim JC, Watts CH, Hargreaves JR, et al. Understanding the impact of a microfinance-based intervention on women's empowerment and the reduction of intimate partner violence in South Africa. Am J Public Health 2007; 97: 1794-1802. CrossRef | PubMed
14 Miller E, Das M, Tancredi DJ, et al. Evaluation of a gender-based violence prevention program for student athletes in Mumbai, India. J Interpers Viol (in press).
15 Miller E, Tancredi DJ, McCauley HL, et al. One-year follow-up of a coach-delivered dating violence prevention program: a cluster randomized controlled trial. Am J Prev Med 2013; 45: 108-112. CrossRef | PubMed
a Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
b Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
c Division of Adolescent Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA, USA
d Center on Gender Equity and Health, Division of Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA


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10 Things You Might Not Know about Women Being Sold fot Sex. 17/09/2013

(From Rest)

Many say prostitution is the oldest profession in the world and believe the private affairs of consenting adults should not be infringed upon.  Those same people are quick to claim that prostitution does not harm anyone.  Perhaps you are one of those people. If that’s the case, I’d like to suggest to you ten things that you might not know about a women being sold for sex.  Statistically speaking:

  1. She was just 13 years old when she entered into the sex trade.
  2. She is a victim of incest. (65% to 90%)
  3. She is the most raped demographic on the planet. (80%)
  4. She will die within 7 years after entering into prostitution.
  5. She has a trafficker selling her as a commodity and keeping all or most of the money. (70%-90%)
  6. She is or has been homeless. (72%)
  7. At some point she has considered suicide. (75%)
  8. She is 40 times more likely to die than the national average.
  9. She is two times more likely than a solider in a war zone to have Post-Traumatic Stress Disorder. (68%)
  10. She is classified by the US Center for Disease Control as having the highest HIV prevalence in the United States.

Learn Ten Things About Men Who Buy Sex.

Bridget Battistoni is Director of Operations for REST: Real Escape from the Sex Trade

1 Estes, Richard J. and Neil A. Weiner. The Commercial Sexual Exploitation of Children in the U.S., Canada, and Mexico. The University of Pennsylvania School of Social Work: 2001
2 The Council for Prostitution Alternatives, Portland, Oregon Annual Report in 1991 stated that: 85% of prostitute/clients reported history of sexual abuse in childhood; 70% reported incest.
3 Susan Kay Hunter and K.C. Reed, July, 1990 “Taking the side of bought and sold rape,” speech at National Coalition against Sexual Assault, Washington, D.C.
4 FBI, 2011
5 Barry, 1995; Norton-Hawk, 2004; Silbert & Pines, 1983b; Williamson & Cluse-Tolar, 2002.
6 Prostitution in Five Countries: Violence and Posttraumatic Stress Disorder” (1998) Feminism & Psychology 8 (4): 405-426.
7 Sisters Speak Out: The Lives and Needs of Prostituted Women in Chicago. Raphael, Jody, and Deborah L. Shapiro. Center for Impact Research, 2002
8 Chris Grussendorf, “No Humans Involved, Part One”,
9 Melissa Farley, Isin Baral, Merab Kiremire, Ufuk Sezgin, “Prostitution in Five Countries: Violence and Post traumatic Stress Disorder” (1998) Feminism & Psychology 8 (4): 405-426; Farley, Melissa et al. 2003. “Prostitution and Trafficking in Nine Countries: An Update on Violence and Posttraumatic Stress Disorder.” Journal of Trauma Practice, Vol. 2, No. 3/4: 33-74; and Farley, Melissa. ed. 2003. Prostitution, Trafficking, and Traumatic Stress. Haworth Press, New York.
10 Common Ground. (n.d.). HYPE: Homeless Youth Peer Education Program. Retrieved July 26, 2007 from http://

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Half of Men Report Using Violence and a Quarter Perpetrate Rape, According to UN Survey of 10,000 Men in Asia-Pacific. 10/9/2013

Bangkok, 10 September 2013

A UN study of 10,000 men in Asia and the Pacific, released today, found that overall nearly half of those men interviewed reported using physical and/or sexual violence against a female partner, ranging from 26 percent to 80 percent across the sites studied.  Nearly a quarter of men interviewed reported perpetrating rape against a woman or girl, ranging from 10 percent to 62 percent across the sites. 

Men were interviewed across nine sites in Bangladesh, Cambodia, China, Indonesia, Sri Lanka and Papua New Guinea. The study, entitled ‘Why Do Some Men Use Violence Against Women and How Can We Prevent It? Quantitative Findings from the UN Multi-country Study on Men and Violence in Asia and the Pacific’ was conducted by Partners for Prevention, a regional joint programme of the UN Development Programme (UNDP), the UN Population Fund (UNFPA), UN Women and United Nations Volunteers (UNV) programme in Asia and the Pacific. It asked men about their use and experiences of violence, gendered attitudes and practices, childhood, sexuality, family life and health.

“This study reaffirms that violence against women is preventable, not inevitable” says James Lang, Programme Coordinator, Partners for Prevention. “Prevention is crucial because of the high prevalence of men’s use of violence found across the study sites and it is achievable because the majority of the factors associated with men’s use of violence can be changed.”

Regarding rape, the study found that in the sites where the survey was conducted:

  • Men begin perpetrating violence at much younger ages than previously thought. Half of those who admitted to rape reported their first time was when they were teenagers; 23 percent of men who raped in Bougainville, Papua New Guinea, and 16 percent in Cambodia were 14 years or younger when they first committed this crime.
  • Of those men who had admitted to rape, the vast majority (72-97 percent in most sites) did not experience any legal consequences, confirming that impunity remains a serious issue in the region.
  • Across all sites, the most common motivation that men cited for rape was related to sexual entitlement – a belief that men have a right to sex with women regardless of consent. Over 80 percent of men who admitted to rape in sites in rural Bangladesh and China gave this response.
  • Overall, 4 percent of respondents said they had perpetrated gang rape against a woman or girl, ranging from 1 to 14 percent across the various sites. This is the first time we have data from such a large sample of men on the perpetration of gang rape.

The study’s findings reaffirm that violence against women is an expression of women’s subordination and inequality in the private and public spheres. The findings show how men’s use of violence against women is associated with men’s personal histories and practices, within a broader context of structural inequalities.

For example, men who reported having perpetrated violence against a female partner were significantly more likely to:

  • Have gender-inequitable attitudes and try to control their partners. For instance, in Bangladesh and Cambodia men who had highly controlling behaviour were more than twice as likely to perpetrate partner violence than those who did not use controlling behaviour.
  • Have experienced physical, sexual or emotional abuse as a child, or witnessed the abuse of their mother. More than 65 percent of men in Bougainville, PNG and the site in China reported experiencing emotional abuse or neglect as children and these men were at least twice as likely to use violence against a female partner.
  • Have practices that celebrate male toughness and sexual performance, such as being involved in fights and paying for sex. In Indonesia and Sri Lanka, men who reported having sex with a sex worker or transactional sex were two times more likely to use violence against a partner than those who had not.

To prevent violence against women, the study recommends we:

  • Make violence against women unacceptable, for example through community mobilization programmes and engagement with people who influence culture;
  • Promote non-violent and caring ways to be a man, for example through sustained school-based or sports-based education programmes;
  • Address child abuse and promote healthy families, for example through parenting programmes, comprehensive child protection systems and policies to end corporal punishment;
  • Work with young people, with a particular focus on boys and adolescents, to understand consent, and healthy sexuality, and to foster respectful relationships;
  • End impunity for men who use violence against women, particularly marital rape, through criminalization of all forms of violence against women, and promote legal sector reform to ensure effective access to justice.
  • Ensure the full empowerment of women and girls and eliminate gender discrimination.

Emma Fulu, Research Specialist for Partners for Prevention says, “We hope to see this new knowledge used for more informed programmes and policies to end violence against women. Given the early age of violence perpetration we found among some men, we need to start working with younger boys and girls than we have in the past. We also need laws and policies that clearly express that violence against women is never acceptable, as well as policies and programmes to protect children and end the cycles of violence that extend across many people’s lives.”

Partners for Prevention is a regional joint programme of the UN Development Programme (UNDP), the UN Population Fund (UNFPA), UN Women and United Nations Volunteers (UNV) programme in Asia and the Pacific.

For more information contact:

Cherie Hart | UN Development Programme Regional Communications Adviser | +66 81 918 1564

Montira Narkvichien | UN Women Communications and Outreach Officer | +66 81 668 8900

William A. Ryan| UNFPA Regional Communications Adviser| | +66 89 897 6984

Rebecca Ladbury | Ladbury PR (London) | +44 (0) 7941 224 975

Notes to editors:

About Partners for Prevention and the UN Multi-Country Study on Men and Violence in Asia and the Pacific

  • The study was conducted in nine sites in six countries and the data is representative of those sites; however it is not representative of the whole Asia-Pacific region nor the entire individual countries (except in Cambodia).
  • Partners for Prevention was established in 2008 to coordinate and strengthen efforts to prevent gender-based violence across Asia and the Pacific. Today, it is comprised of a team of programme specialists based in Bangkok, regional UN advisers in Bangkok, Delhi and Bonn, and UN partners based in country offices around the region. The joint programme brings together the combined strengths of the four partner agencies – and a wide array of other partners – in a concerted effort to promote evidence- and theory-based approaches to prevention, including those that work with boys and men alongside girls and women, to transform gender inequitable attitudes, practices and social norms. The programme has received financial support from the Governments of Australia, the United Kingdom, Norway and Sweden.
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Analysis: Why Men Rape in Asia - UN study.10/09/2013

JAKARTA, 10 September 2013 (IRIN) - Nearly one in four men surveyed in the Asia-Pacific region admitted raping a woman or girl, according to the first multi-country study on the prevalence of rape and partner violence and the reasons behind it.

While the prevalence of reported rape of non-partners was high across the Asia-Pacific, sexual violence against female partners was more widespread, according to the UN study, which interviewed some 10,000 men and 3,100 women in Bangladesh, Cambodia, China, Indonesia, Sri Lanka and Papua New Guinea (PNG) between 2010-2013.

Rather than being asked whether they had committed rape or violence against women, the men were instead asked: “Have you ever forced a woman who was not your wife or girlfriend at the time to have sex?” and “Have you ever had sex with a woman who was too drugged to indicate whether she wanted it?”

Responses in PNG showed the highest rate of violence against women in the region, with about 62 percent of the men interviewed there indicating they had raped a woman.

Some men reported experiencing rape by other men as adults. The lowest prevalence of male rape, 2 percent, was found in the Indonesian cities of Jayapura, capital of Papua Province, and Jakarta, the national capital, while the highest, at 8 percent, was in Bougainville, PNG.


The autonomous region of Bougainville in PNG was devastated by a violent civil war - among the longest and bloodiest in the Pacific - between separatist rebels and the government from 1989-1998.

Thousands of residents, some 10 percent, died in the conflict, in which rebels and government forces alike reportedly “used rape, humiliation and forced marriage as war tactics”, according to a 1997 Amnesty International report.

Interviews conducted by the UN Development Fund for Women (UNIFEM) in 2003 indicated criminal groups used the conflict to justify rape. A nun told UNIFEM that life for women during the conflict was like living “between two guns”.

In the years following the conflict, women continued to feel threatened by weapons still in circulation, according to one local development agency cited by UNIFEM.

But even outside this bloody theatre of war, and years later, the situation remains grim for women.

"The problem is bad. We pretend that it is not there," Ume Wainetti, head of the Family and Sexual Action Committee, a government programme set up to address gender violence, told IRIN in March 2012.

The country’s National Executive Council (similar to a cabinet) has endorsed a Family Protection Act, which is currently before parliament. It would criminalize domestic violence, strengthen 2009 legislation prohibiting violence against children and enforce protection orders.


Masruchah, deputy chairwoman of the independent National Commission on Violence Against Women, which was founded by the government of Indonesia, told IRIN that gender violence in Indonesia remains widespread, even after the government issued legislation to protect women; a 1984 law bans discrimination against women while a 2004 law criminalizes domestic violence.

"The men's admission is the tip of the iceberg," said Masruchah, who like many Indonesians goes by one name. "Very few men are honest enough to admit they have committed rape."

The commission recorded more than 216,000 cases of violence against women in 2012 (the country has an estimated 118 million women), with at least 20 women being raped daily in Indonesia, she said. And these are only incidents reported to authorities.

"Very few men are honest enough to admit they have committed rape"

Masruchah said women in Indonesia are often resigned to the dominant cultural perspective on gender violence.

"Many victims choose not to report because of family pressure, and sometimes because communities put the blame on them," she said. "Police often have to release perpetrators of sexual violence at the request of their wives and partners."

"Law enforcers also apply outdated definition of rape requiring evidence such as blood and semen," she added.

The majority of men cited in the UN study who perpetrated rape, especially marital rape, did not report any legal consequences. Marital rape was the most common form of rape, according to the study, but is not criminalized in many of the countries studied; gang rape was the least common form of rape admitted by respondents.


The most common motivation perpetrators gave for rape was a sense of sexual entitlement - the belief that men have a right to sex with women regardless of consent (73 percent of respondents). More than half said it was for entertainment (53 percent), while alcohol, often assumed to be a common trigger for violence, was the least common response.

Men who had themselves been victimized - abused, raped or otherwise sexually coerced - were more likely to commit rape than those who were not, the study found. Past violence toward a partner, having paid for sex or having had many sexual partners were all associated with increased likelihood of raping a non-partner.

Findings from study on men and violence in Asia/Pacific
Half of the men who had perpetrated rape did so for the first time when they were teenagers (younger than 20).
Men’s reported perpetration of gang rape in their lifetime ranged from 1 percent to 14 percent across the nine sites.
Most men who had raped a man had also raped a female non-partner.
Rural Indonesia had the lowest prevalence of physical or sexual violence against partners (25 percent) reported by respondents, while Bougainville, PNG had the highest (80 percent).
Gang rape was the least common form of rape (4 percent average across the nine countries), except in Cambodia, where it was more common than non-partner rape by a man acting alone.
Forty-six percent of men who had ever been in a relationship reported having committed some form of violence or abuse against their partners.
Rural Bangladesh reported the lowest incidence of rape against female non-partners, at 3 percent, compared to a high of 27 percent in PNG.
In Indonesia, 26 percent of men said they had committed physical or sexual violence against partners, versus 80 percent in PNG.

Emma Fulu, a researcher at Partners for Prevention, a joint programme of the UN Development Programme, the UN Population Fund, UN Women (the successor of UNIFEM) and the UN Volunteers programme in the Asia and the Pacific, based in Bangkok, Thailand, that conducted the survey, wrote in the UK medical journal The Lancet: “Surprisingly, our results show that although some overlap exists, physical and sexual violence do not always appear to be committed together, or for the same reasons, in different regions.”

In the same journal Rachel Jewkes of South Africa’s Medical Research Council concluded: “In the view of the high prevalence of rape worldwide, our findings clearly show that [rape] prevention strategies need to show increased focus on the structural and social risk factors for rape. We now need to move towards a culture of preventing the perpetration of rape from ever occurring, rather than relying on prevention through responses.”

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Partner Violence may Undermine use of Female-Controlled forms of HIV Prevention. 27/08/2013


Michael Carter

Women who experience violence from their male partner are less likely to use condoms or diaphragms, an international team of investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Intimate partner violence (IPV) increased the risk of condom non-use by up to 47% and non-use of diaphragms by a quarter.

The authors believe the association between partner violence and not using a diaphragm could have implications for research into microbicides and other forms of HIV prevention under female control: “IPV is likely to impede adherence to HIV prevention interventions, even those that are specially designed to give women greater control over protecting their sexual health.”

HIV and intimate partner violence are highly prevalent in southern Africa. Previous research has shown that women who experience violence from a male partner are more likely to report inconsistent condom use, multiple sexual partners and to have higher rates of sexually transmitted infections and HIV.

“Women who experience IPV may be unsuccessful in their efforts to negotiate condoms, or be less likely to refuse sex or to suggest the use of condoms because they fear violence,” write the authors.

Female-initiated methods of HIV prevention can potentially give women more control over sexual decision-making. However, investigators were concerned that the real-world effectiveness of these interventions may be reduced for women experiencing intimate partner violence.

To see if this was the case they designed a 24-month longitudinal study involving 4505 women recruited to the Methods for Improving Reproductive Health in Africa (MIRA) study. Recruitment took place between 2003 and 2006 in South Africa and Zimbabwe. Participants were randomised to receive diaphragms, lubricant and condoms or condoms alone.

The women were interviewed about their experiences of intimate partner violence at baseline and again twelve and 24 months after randomisation. Data were gathered on adherence to diaphragm and condom use and the investigators explored the association between intimate partner violence and non-adherence.

Overall, 55% of women reported intimate partner violence during at least one follow-up visit.

Specifically, 41% reported fearing violence from their male partner, 34% reported that their male partner had emotionally abused them, 16% said their male partner had physically assaulted them and 15% reported that their male partner had forced them to have sex.

After adjusting for potential confounders, there was a significant relationship between intimate partner violence and condom non-adherence (intervention arm =  AOR, 1.47; 95% CI, 1.28-1.69; control arm =  AOR, 1.41; 95% CI, 1.24-1.61).

Experiencing intimate partner violence also associated with diaphragm non-adherence (AOR,1.24; 95% CI, 1.06-1.45).

At all study points, there was a significant relationship between partner violence and non-adherence to condom or diaphragm use.

Women in the control arm who experienced persisting (AOR, 2.02; 95% CI, 1.54-3.1) and incident partner violence (AOR, 1.69; 95% CI, 1.08-2.6) had higher odds of reporting condom non-adherence compared to women who did not report violence at baseline or at the twelve month follow-up visit.

Women in the intervention arm who reported persisting violence were significantly more likely than women who did not report intimate partner violence to report condom non-adherence (AOR, 1.53; 95% CI, 1.06-2.2) and diaphragm non-adherence (AOR, 2.0; 95% CI, 1.39-2.9).

“Interventions and policies that explicitly address IPV and the links to HIV infection risk are urgently needed,” comment the authors. “Research that identifies multilevel determinants of men’s perpetration of IPV and evaluates targeting young men and women should be a high priority.”


Kacanek D et al. Intimate partner violence and condom and diaphragm non-adherence among women in an HIV prevention trial in Southern Africa. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097/QAI.0b013e318a6b0be, 2013.

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Confronting Gender Inequality and Bringing About Reconciliation Between Men and Women - 21/08/2013

These are the main aims of a new gender reconciliation partnership between the

Desmond & Leah Tutu Legacy Foundation

, Gender Reconciliation International (GRI) and Stellenbosch University (SU), launched on Tuesday 20 August 2013.

Archbishop Emeritus Desmond Tutu, SU Rector and Vice-Chancellor Prof Russel Botman, GRI founders Dr William Keepin and Rev Cynthia Brix and Chief Executive Officer of the Desmond & Leah Tutu Legacy Foundation Rev Mpho Tutu were part of a panel discussing this new partnership and the reasons behind it.

The event was held at SU’s Tygerberg Campus.

The partnership will focus on the implementation of gender reconciliation, applying principles of South Africa’s truth and reconciliation process to restore people’s faith in one another.

“Gender Reconciliation International has been engaged in Gender Reconciliation for 21 years, and its work resonates with two of the Desmond and Leah Tutu Legacy Foundation’s pillars – to advance mutual respect, and to enhance human wellbeing,” said Rev Tutu.

Archbishop Tutu emphasised the role of women in society and spoke about how they are treated.

“For goodness’ sake, for our sake, women have to be acknowledged for who they are. We have to recover the humanity of women. We undermine our own humanity if we undermine women,” he said.

Prof Botman thanked the representatives of GRI and the Desmond & Leah TutuLegacy Foundation that Stellenbosch University can be part of this project.

“This year represents a milestone in SA higher education. The first ‘born frees’ have enrolled on our campuses. But in February, we buried a ‘born free’, 17-year-old Anene Booysen of Bredasdorp after she was brutally raped and left for dead.

“We need to develop a new set of young people who think differently and who have a new set of values,” he said. “It is important for us to think again about where we are and where we are going. Our task is to find champions for the cause.”

Dr Keepin emphasised that both men and women are affected by gender inequality and that they need each other to address the issue.

“We have to come together and jointly confront gender inequality,” he said.

The initial focus of the partnership will be a series of introductory workshops and a facilitator training programme. SU’s Frederik van Zyl Slabbert Institute for Student Leadership Development (FVZS Institute) will be used as a platform to roll out the programme.

The GRI project will train approximately 25 student leaders between the ages 18 and 30 years in gender reconciliation facilitation, a process for healing and reconciliation of dysfunctional gender dynamics and behavioural patterns between men and women in South Africa. The trained facilitators will then be able to facilitate GR workshops for theirpeers under the supervision of a qualified GR Trainer.

Rev Tutu said the partnership was being launched at SU but they hope to roll it out to all universities in South Africa eventually.


For more information please call Ms Tamu Matose of the Desmond & Leah Tutu Legacy Foundation at on 021 552 7524 / 079 878 7829.

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Bishop Tutu at Old Mutual Women's Day Event. 14/08/2013

Desmond & Leah Tutu Legacy Foundation


Long, long ago – in the years before even I was born – men’s physical strength gave them what marketer’s today might term “a competitive edge”. I would imagine that physical strength was an important consideration when hunting mammoths, for example – or hurling rocks.

Later, when human beings developed the weapons to do each other serious harm in large numbers, it was mostly the men who “excelled” in war, who led the slave trade, who robbed, raped and pillaged, and ruled the world.

Times have changed, but many of us men have not. And in some respects, nor has our world changed much, either.

Greed, materialism, consumptiveness and power-lust cause us (usually men) to do awful things to one another (men, women and children) and the earth we share.  We are poised at the edge of the abyss, and it is men who have driven us here mostly.

We gave up hunting mammoths some time ago. We have given up on trench warfare and bayonet charges, and most other forms of hand-to-hand combat. Surely the technological age has rendered physical strength obsolete – except perhaps on the rugby field?

Yet men continue to occupy most positions of leadership, from industry to commerce, to the church, to government. Why?

This is not a question of supremacy or superiority, but one of necessity for our collective survival. Brute force is not going to resolve anything. There is a need for a new type of courageous and compassionate leadership. Ubuntu-based leadership; leadership that recognises our inter-dependence and our complementarity.

Sadly, these are qualities that are only very seldom found in men. Happily, they are found in abundance in women.

There is a need to fundamentally turn around our thinking about gender equality – it begins in our homes, with our families, at work and at school, and in our communities. We need to develop our societies in a way that care for others is regarded as a necessity, and not necessarily a charitable gesture or part of a company’s must-have corporate social investment portfolio. As they say, “Make every day a Mandela Day!”

We must ask: How is it that a society such as ours, with such a proud record of overcoming racial discrimination, can be so tolerant of gender discrimination and the brutalisation of women by men?

Yes, we have one of the world’s most progressive Constitutions on matters of equality and the recognition of our mutual rights. Yes, we are a society in transition, still deeply disturbed by the wounds of our past. And we are battling to narrow the wealth gap, resulting in many of our people continuing to live in conditions that place them at risk.

But, NO, these excuses are not acceptable. NO, we should not allow ourselves to become blasé about the rape of our women and children, as if this inhuman behaviour were somehow “normal”. NO, we should not expect men to fix the problem alone.

As we speak, men are leading military offensives in so-called “trouble spots” across the world. Men from the north are leading multinational companies prospecting for mineral and energy resources in the south. Men control most of the world’s governments and resources and religions.

Women, the glue holding families and communities together, suffer most as a result of men’s endeavours.

As citizens of Cape Town, politically-speaking, we have women at the helm of our city and our province, and our parliament has among the world’s highest representation of women. When it comes to business, we have had BEE and now BBBEE, policies that have actively encouraged the participation of women in our economy. We have had woman at the helm of our universities, and among the top ranks of our professionals.

But this is clearly not good enough. We need a new revolution, beginning in our homes, that recognises women as the heartbeat and spine of our human family. We need to agitate for women to hold positions of leadership in our organisations, in our schools, in our businesses and our places of worship. And we need to develop the strength to speak out against prejudice and discrimination wherever we find it, to speak out against sexism and gender intolerance – to speak out for compassion and love.

Many years ago, in the Garden of Eden, God recognised a vital truth: God looked at Adam and pronounced that the garden was not for man, alone. Man could not survive, alone. Women were and are indispensible for our very existence.

Let us acknowledge and honour women every day.

God bless you.

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“Corrected” and Left With HIV

Lungile Dladla says she is not a victim of "corrective" rape but a victor. (SABC)

She lay in the hospital bed, struggling to breathe. She couldn’t understand why she was shivering in the middle of a December summer.  “My time has come,”she thought.  "My story is ending here, another lesbian with a short life, "but instead, she left the hospital alive and HIV positive.

Lungile Cleo Dladla, 27 years old, from Daveyton, east of Johannesburg - like many other lesbians - never thought she was at risk of contracting HIV. She says she never thought her condition would be linked to her body being violated by a man who wanted to 'teach her a lesson'.

Around 10% of women who have sex with women were found to be HIV-positive in four southern African countries. This is according to a new study led by the Human Sciences Research Council (HSRC) of South Africa and Columbia University. The study was conducted with over 500 lesbian women - mainly black South Africans.  

One in Nine’s Campaign Coordinator, Carrie Shelver, says there are not many studies which have looked at gender based violence perpetrated against lesbian women. Shelver says from their interactions with various communities, they have seen a high level of infected women.

Investigator Dr Theodorus Sandfort of the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University says that the findings suggest that the main source of infection among lesbians is likely rape or forced sex.

Dladla recalls the day her life changed.  It was the month of love, February 2010 and they were in a field as the sun was setting.  She had been walking home with her friend, Mathapelo, after a family funeral through a field they had gone through many times when they were accosted by a man in a hoodie with his face covered.

Lesbians are targeted with the belief that they can be 'cured' or 'corrected' of their same-sex attraction.

“He was walking in the opposite direction, but when we passed him, he turned towards us. He began following us and guided us to a secluded place.  We followed him as he had a gun and we feared for our lives,” she says.

They lay there naked, two girls, bound by their hands and legs - the mosquitoes feeding on their skin in the dry heat. Under normal circumstances, it would have been a romantic date, but he was there - hoping to be the man to change their sexual preference.

The rape of lesbians - most cases being predominantly black - often happens under these circumstances. This has led to the coining of the term, 'corrective rape' or 'curative rape'.  Lesbians are targeted with the belief that they can be 'cured' or 'corrected' of their same-sex attraction.

Prof Vasu Reddy of the HSRC says: “The biggest problem identified was the issue of forced sex. The study revealed that over 31% of participants reported having being forced to indulge in sex by both men and women.”Dladla discovered she was HIV positive a year after the rape when she was hospitalised. She says when they reporting the rape that evening, the police refused to take her statement claiming she was a boy.

“The police asked 'You were raped? How? That is impossible, you‘re a guy!' I asked them how I could be male with breasts. If it was not for the girl I used to go to school with, those stupid people would have not taken my statement,” she says.

The risk of 'corrective' rape victims contracting HIV or other sexually transmitted diseases is compounded by fear of stigmatisation.

Shelver says they are at an early stage of researching cases of lesbians who have been raped and exposed to the risk of contracting HIV but do not get the proper assistance, later testing positive.

In Dladla's case, the police also did not have a crime kit available and asked the girls to return the next morning without bathing. “We returned the next day and they gave us some pills, but I do not know what it was for - they never told us.”

Dladla and Mathapelo where not examined despite there being a clinic close to the police station.

According to SAPS guideline on reporting a rape, “When you report, the police will take you to hospital where you will be given medication to prevent HIV/Aids.”  

Rape Crisis explained that a rape victim is entitled to the Morning after Pill, HIV testing, antiretroviral treatment as well as antibiotics to prevent getting any sexually transmitted infections within 72 hours of being raped. This is procedure followed whether the victim wants to report the matter or not.

Dladla’s story is not unique but a reality that many black lesbians in South Africa endure. Dladla started speaking out after a friend’s partner in Soweto hanged herself in 2011 after she found out she was HIV positive.  “I won’t keep quiet 'till I am in my grave”, she says.

Luleki Sizwe - an organisation that advocates against corrective rape in South Africa - was founded in memory of Luleka Makiwane and Nosizwe Nomsa Bizana, who both contracted HIV after being raped for their sexual orientation.

The group states: “The stories of Luleka and Nosizwe are not the only ones. There’s a general belief that lesbian women are a low risk group in terms of sexually transmitted diseases and especially HIV/AIDS. This opinion does however not take into consideration the high levels of rape, also called corrective rape, that particularly township-based lesbians are exposed to and which puts them at risk for STI’s and HIV/AIDS."

Duduzile Zozo’s body was found on June 30 near the house where she lived with her mother in a township east of Johannesburg. She was allegedly beaten to death with a brick and left to die with a toilet brush inserted into her vagina.

A number of other lesbians have been killed in various 'hate crime' incidents in the country.

Dladla becomes somber as she remembers Patricia Mashigo who was found dead after apparently being stoned to death. Another activist she talks about is Noxolo Nogwaza who was raped and murdered with a piece of concrete paving in 2011.

Dladla says she is an open lesbian and is often confused for a male due to her appearance.  She says she gets harassed more about her appearance than her sexuality.

In her community Dladla says she has received threats from men who threatened to 'come finish her'. She says many men accuse the lesbian community of 'stealing' their women.

Dladla subsequently left the hospital two months later, after battling a lung infection and PCP Pneumonia.  “I left the hospital with a CD4 count of one but now I’m healthy and alive.” she says

Dladla says that she refuses to be a victim but is a victor.

Hasina Gori is an IWMF HIV/AIDS Reporting Fellow Published.

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Seven Governments Adopt Statement on Violence against Women and Girls at 66th World Health Assembly. 07/2013

In the context of the annual gathering of the world's ministers of health, seven governments - Belgium, India, Mexico, Netherlands, Norway, United States of America, and Zambia - issued a statement at the conclusion of a panel discussion declaring violence against women and girls "a major global public health, gender equality and human rights challenge, touching every country and every part of society" and proposing an agenda item on the topic for the 67th World Health Assembly.

The statement which was read by Ms Kathleen Sebelius, Secretary of Health and Human Services of the United States, recognizes WHO's work to date in preventing violence against women as fundamental in highlighting the magnitude of and outlining the factors associated with this global scourge. It notes that the health sector has a key role to play in preventing and responding to the problem, as part of a robust multi-sectoral approach that engages governments and civil society, on the local, national and international level. The statement also recognizes WHO's leadership in ensuring that the public health approach to violence prevention more broadly is widely understood and being acted on by an increasing numbers of countries.

The lively panel discussion on "Addressing violence against women: health impacts and the role of the health sector" featured the African Union's Commissioner for Social Affairs; Ministers of Health or their representatives from Belgium, India, Mexico, the United States and Zambia; and the Minister of Foreign Trade and Development from the Netherlands. Panellists highlighted how violence against women is being addressed in several countries.

India's Secretary of Health and Family Welfare Desiraju described how his government has broadened the definition of rape to criminalize a greater set of violations and better protect women, while Zambia's Minister Kasonde identified leadership - of Zambia's first lady, the country's traditional chiefs, the police and others - as key to making progress on preventing violence against women in his country. The Netherland's Minister Ploumen called women powerful agents of peace and security, and noted the importance of empowering women as a vital component of the country's development cooperation strategy.

Secretary Sebelius pointed out the decline in intimate partner violence in the United States by two thirds from 1993 to 2010. She attributed this progress to a change in culture, attitude and norms, derived from enhanced gender equality, a better criminal justice response, improved services for victims and more effective prevention. Like Secretary Sebelius, ministers from Belgium, the Netherlands and Mexico and the commissioner from the African Union noted the importance of being able to talk about violence against women and girls, in terms of bringing the discourse out of the private sphere behind closed doors and into the public domain.

WHO commended the efforts described by panellists, recognizing that more work needs to be done in advocacy, data collection, policy, services and addressing the root causes of violence to enable prevention. WHO welcomed the statement which notes that this event marks the beginning of a process to address this issue with renewed vigor, calls for improved coordination across all UN agencies, and proposes a discussion on the topic for the 67th World Health Assembly.

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Violence & Silence: Jackson Katz, Ph.D at TEDxFiDiWomen

 Jackson Katz, Phd, is an anti-sexist activist and expert on violence, media and masculinities. An author, filmmaker, educator and social theorist, Katz has worked in gender violence prevention work with diverse groups of men and boys in sports culture and the military, and has pioneered work in critical media literacy.Katz is the creator and co-founder of the Mentors in Violence Prevention (MVP) program, which advocates the 'bystander approach' to sexual and domestic violence prevention. You've also seen him in the award winning documentary "MissRepresentation." To learn more about TEDxFiDiWomen, whether to attend, volunteer, speak or sponsor, please click on the following link! To learn more about Jackson Katz, please visit In thespirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TEDTalks video and live speakers combine to spark deep discussion and connection in a small group. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized.* (*Subject to certain rules and regulations)

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Violence Against Women Worldwide is 'Epidemic' 01/07/2013

BBC News: Health Posted 20 June 2013

Silhouette of a woman protecting herself from a blow from her partner The most common type of violence against women is by an intimate partner, the report says.  More than one in three women worldwide have experienced physical or sexual violence, a report by the World Health Organization and other groups says.

It says 38% of all women murdered were killed by their partners, and such violence is a major contributor to depression and other health problems.

WHO head Margaret Chan said violence against women was "a global health problem of epidemic proportions".

The study also calls for toleration of such attacks worldwide to be halted.

And it says new guidelines must be adopted by health officials around the world to prevent the abuse and offer better protection to victims.

'Fear of stigma'

The report on partner and non-partner violence against women was released by the WHO, the London School of Hygiene and Tropical Medicine (LSHTM) and the South African Medical Research Council (SAMRC).

Its authors say it is the first systematic study of global data, detailing the impact of the abuse on both the physical and mental health of women and girls.

The key findings are:

  • violence by an intimate partner is the most common type of abuse, affecting 30% of women across the globe
  • 38% of all women murdered were killed by their partners
  • 42% of women physically or sexually abused by partners had injuries as a result
  • Victims of non-partner attacks were 2.6 times more likely to experience depression and anxiety compared with women who had not experienced violence
  • Those abused by their partners were almost twice as likely to have similar problems
  • Victims were more likely to have alcohol problems, abortions and acquire sexually transmitted diseases and HIV

"This new data shows that violence against women is extremely common," said report co-author Prof Charlotte Watts from the LSHTM.

"We urgently need to invest in prevention to address the underlying causes of this global women's health problem."

The document adds that "fear of stigma" prevents many women from reporting sexual violence.

It stresses that health officials around the world need to take the issue "more seriously", providing better training for health workers in recognising when women may be at risk of violence and ensuring an appropriate response.

The WHO says it will start implementing new guidelines together with other organisations at the end of June.

Women who have suffered violence from a partner (%)

WHO Region Prevalence
Low and middle-income regions  
AFRICA (Botswana, Cameroon, DR Congo, Ethiopia, Kenya, Lesotho, Liberia, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, Tanzania, Zambia, Zimbabwe 36.6%
AMERICAS (Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Paraguay, Peru, Bolivia) 29.8%
EASTERN MEDITERRANEAN (Egypt, Iran, Iraq, Jordan, Palestinian territories) 37.0%
EUROPE (Albania, Azerbaijan, Georgia, Lithuania, Rep of Moldova, Romania, Russia, Serbia, Turkey, Ukraine) 25.4%
SOUTH-EAST ASIA (Bangladesh, East Timor, India, Burma, Sri Lanka, Thailand) 37.7%
WESTERN PACIFIC (Cambodia, China, Philippines, Samoa, Vietnam) 24.6%
High income (Australia, Canada, Croatia, Czech Republic, Denmark, Finland, France, Germany, Hong Kong, Iceland, Ireland, Israel, Japan, Netherlands, New Zealand, Norway, Poland, South Korea, Spain, Sweden, Switzerland, UK, US) 23.2%
Source: WHO, London School of Hygiene & Tropical Medicine, South African Medical Research Council

Women who have suffered violence from someone who was not their partner (%)

WHO Region Prevalence
Low and middle income  
Africa 11.9%
Americas 10.7%
Eastern Mediterranean No Data
Europe 5.2%
South-East Asia 4.9%
Western Pacific 6.8%
High income 12.6%
Source: WHO, London School of Hygiene & Tropical Medicine, South African Medical Research Council
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Canada Ignores the Importance of Sexual and Reproductive Health Rights in Addressing Rape 27/06/2013

Amnesty International (Ottawa)

In a deeply troubling and unprecedented turn of events, Canada put forth text at the United Nations Human Rights Council on Monday which ignores an important need of rape survivors and fails to take account of recent international progress in tackling violence against women around the world.

Since 1994, Canada has led the negotiation of resolutions on violence against women in the UN Human Rights Council (and before 2006 the UN Commission on Human Rights), making the resolution progressively stronger each year. As such, it is all the more disappointing that this year’s draft resolution is so weak on the importance of sexual and reproductive health as an essential element in efforts to address violence against women.

The proposed resolution excludes references to sexuality education and a number of essential services that must be made available to survivors of sexual violence. The international community, including Canada, has previously agreed that adolescents should have access to sexuality education and that survivors of sexual violence should have access to sexual and reproductive health services. It has been recognized that education and necessary health services play a fundamental role in responding to the widespread violence that women and girls continue to face in every corner of the world. The resolution as drafted does not adequately address these rights-based measures that are central to the global effort to better protect women from violence.

“The rights of women and girls continue to be violated around the world.  Amnesty International’s research demonstrates that shocking levels of violence are still a daily reality for women and girls everywhere,” said Alex Neve, Secretary-General of Amnesty International Canada (English Branch). “From women in the Democratic Republic of the Congo to First Nations, Métis, and Inuit women and girls in Canada—all rape survivors have the right to life, physical security, equality and the right to health. For these rights to be realized, women and girls must have access to comprehensive sexual and reproductive health services, and they need champions in government to stand up for these rights.”

In human rights agreements dating back 20 years, Canada has supported the rights of all women and girls, including rape survivors, to have access to sexual and reproductive health services. “Does Canada no longer care about sexual and reproductive health services and their vital importance for survivors of rape?” said Béatrice Vaugrante, Director General of Amnesty International Canada’s francophone branch. “This is not about a piece of paper being circulated at the United Nations—this is an important international decision that sets the ground for Canada’s policies on sexual and reproductive rights and funding priorities both at home and abroad.”

Canada’s failure to stand up for recognized international human rights standards has taken other governments by surprise.  At this stage, some countries that have traditionally actively supported this resolution through co-sponsorship are indicating that they will likely not do so this year. The provisions in the draft resolution, including those dealing with marital rape and with early and forced marriage, do make welcome and important contributions to addressing violence against women.  However, these omissions with respect to sexuality education and access to sexual and reproductive rights services remain glaring and deeply problematic.

Amnesty International calls on Canada, as the country that leads the negotiations around this resolution on violence against women, to work quickly and actively to reintroduce stronger language on sexual and reproductive health rights in the text. Without such language, this resolution will be seriously incomplete.

Adoption of the draft resolution by the Human Rights Council is expected on Friday 14 June 2013.

For further information or to arrange interviews, please contact: Elizabeth Berton-Hunter, Media Relations 416-363-9933 ext 332,

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One In 3 Women Experience Sexual, Physical Violence, WHO Report Says. 21/6/2013

“One in three women experience sexual or physical violence — most likely from their intimate partner, according to a report from the [WHO],” CNN reports (Park, 6/20). “The report, ‘Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence,’ represents the first systematic study of global data on the prevalence of violence against women — both by partners and non-partners,” the U.N. News Centre writes (6/20). “Put together by the WHO in partnership with the London School of Hygiene & Tropical Medicine and the South African Medical Research Council, the report says 35 percent of women around the world are victims of sexual or physical violence, and that assault at the hands of an intimate partner is by far the most common form of such violence,” the Huffington Post’s “World” blog notes (Mosbergen, 6/20). “Among the findings: 40 percent of women killed worldwide were slain by an intimate partner, and being assaulted by a partner was the most common kind of violence experienced by women,” the Associated Press adds (Cheng, 6/20). “Topping the regional list is WHO’s South-East Asia administrative region, which includes India, Bangladesh, and Thailand, where an estimated 37.7 percent of women [were found to have been] beaten or sexually assaulted by a spouse or intimate partner,” National Geographic’s “News Watch” writes (Morrison, 6/20). “The report says women of all ages, young and old alike, are subject to violence,” according to VOA News (Schlein, 6/20).

“Such figures mean that violence should be considered alongside ‘mainstream’ health risks such as smoking and alcohol use, says Kristin Dunkle, a social epidemiologist at Emory University in Atlanta, Georgia, who was not involved in the studies,” Nature writes (Baker, 6/20). “The report found that violence against women is a root cause for a range of acute and chronic health problems, ranging from immediate injury to sexually transmitted infections, to HIV, to depression and stress- and alcohol-related health disorders,” Reuters reports (Kelland, 6/20). “The head of the [WHO], Dr. Margaret Chan, called it ‘a global health problem of epidemic proportions,’ and other experts said screening for domestic violence should be added to all levels of health care,” the AP writes (6/20). “‘The main message is that this problem affects women everywhere,’ [Karen Devries, an epidemiologist from the London School of Hygiene & Tropical Medicine] says,” NPR’s “Shots” blog states. “Because of the stigma associated with rape and abuse, ‘some of our findings may underestimate the prevalence,’” Devries said, the blog notes (Doucleff/Chatterjee, 6/20). “The study highlights the need for all sectors to engage in eliminating tolerance for violence against women and [improving] support for women who experience it,” according to a WHO press release, which adds, “New WHO guidelines, launched with the report, aim to help countries improve their health sector’s capacity to respond to violence against women” (6/20). The Guardian’s “Data Blog” details some of the findings of the report (Chalabi/Holder, 6/20).

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WHO Report Highlights Violence against Women as a ‘Global Health Problem of Epidemic Proportions’. 20/6/2013


New clinical and policy guidelines launched to guide health sector response

Physical or sexual violence is a public health problem that affects more than one third of all women globally, according to a new report released by WHO in partnership with the London School of Hygiene & Tropical Medicine and the South African Medical Research Council.

The report, Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence, represents the first systematic study of global data on the prevalence of violence against women – both by partners and non-partners. Some 35% of all women will experience either intimate partner or non-partner violence. The study finds that intimate partner violence is the most common type of violence against women, affecting 30% of women worldwide.

The study highlights the need for all sectors to engage in eliminating tolerance for violence against women and better support for women who experience it. New WHO guidelines, launched with the report, aim to help countries improve their health sector’s capacity to respond to violence against women.

Impact on physical and mental health

The report details the impact of violence on the physical and mental health of women and girls. This can range from broken bones to pregnancy-related complications, mental problems and impaired social functioning.

“These findings send a powerful message that violence against women is a global health problem of epidemic proportions,” said Dr Margaret Chan, Director-General, WHO. “We also see that the world’s health systems can and must do more for women who experience violence.”

The report’s key findings on the health impacts of violence by an intimate partner were:

  • Death and injury – The study found that globally, 38% of all women who were murdered were murdered by their intimate partners, and 42% of women who have experienced physical or sexual violence at the hands of a partner had experienced injuries as a result.
  • Depression – Partner violence is a major contributor to women’s mental health problems, with women who have experienced partner violence being almost twice as likely to experience depression compared to women who have not experienced any violence.
  • Alcohol use problems – Women experiencing intimate partner violence are almost twice as likely as other women to have alcohol-use problems.
  • Sexually transmitted infections – Women who experience physical and/or sexual partner violence are 1.5 times more likely to acquire syphilis infection, chlamydia, or gonorrhoea. In some regions (including sub-Saharan Africa), they are 1.5 times more likely to acquire HIV.
  • Unwanted pregnancy and abortion – Both partner violence and non-partner sexual violence are associated with unwanted pregnancy; the report found that women experiencing physical and/or sexual partner violence are twice as likely to have an abortion than women who do not experience this violence.
  • Low birth-weight babies – Women who experience partner violence have a 16% greater chance of having a low birth-weight baby.

“This new data shows that violence against women is extremely common. We urgently need to invest in prevention to address the underlying causes of this global women’s health problem.” said Professor Charlotte Watts, from the London School of Hygiene & Tropical Medicine.

Need for better reporting and more attention to prevention

Fear of stigma prevents many women from reporting non-partner sexual violence. Other barriers to data collection include the fact that fewer countries collect this data than information about intimate partner violence, and that many surveys of this type of violence employ less sophisticated measurement approaches than those used in monitoring intimate partner violence.

“The review brings to light the lack of data on sexual violence by perpetrators other than partners, including in conflict-affected settings,” said Dr Naeemah Abrahams from the SAMRC. “We need more countries to measure sexual violence and to use the best survey instruments available.”

In spite of these obstacles, the review found that 7.2% of women globally had reported non-partner sexual violence. As a result of this violence, they were 2.3 times more likely to have alcohol disorders and 2.6 times more likely to suffer depression or anxiety – slightly more than women experiencing intimate partner violence.

The report calls for a major scaling up of global efforts to prevent all kinds of violence against women by addressing the social and cultural factors behind it.

Recommendations to the health sector

The report also emphasizes the urgent need for better care for women who have experienced violence. These women often seek health-care, without necessarily disclosing the cause of their injuries or ill-health.

“The report findings show that violence greatly increases women’s vulnerability to a range of short- and long-term health problems; it highlights the need for the health sector to take violence against women more seriously,” said Dr Claudia Garcia-Moreno of WHO. “In many cases this is because health workers simply do not know how to respond.”

New WHO clinical and policy guidelines released today aim to address this lack of knowledge. They stress the importance of training all levels of health workers to recognize when women may be at risk of partner violence and to know how to provide an appropriate response.

They also point out that some health-care settings, such as antenatal services and HIV testing, may provide opportunities to support survivors of violence, provided certain minimum requirements are met.

  • Health providers have been trained how to ask about violence.
  • Standard operating procedures are in place.
  • Consultation takes place in a private setting.
  • Confidentiality is guaranteed.
  • A referral system is in place to ensure that women can access related services.
  • In the case of sexual assault, health care settings must be equipped to provide the comprehensive response women need – to address both physical and mental health consequences.

The report’s authors stress the importance of using these guidelines to incorporate issues of violence into the medical and nursing curricula as well as during in-service training.

WHO will begin to work with countries in South-East Asia to implement the new recommendations at the end of June. The Organization will partner with ministries of health, non-governmental organizations (NGOs) and sister United Nations agencies to disseminate the guidelines, and support their adaptation and use.

Notes to Editors:

In March 2013, Dr Chan joined the UN Secretary General and the heads of other UN entities in a call for zero tolerance for violence against women at the Commission on the Status of Women in New York. During the Sixty-sixth World Health Assembly in May 2013, seven governments - Belgium, India, Mexico, Netherlands, Norway, United States of America, and Zambia - declared violence against women and girls "a major global public health, gender equality and human rights challenge, touching every country and every part of society" and proposed the issue should appear on the agenda of the Sixty-seventh World Health Assembly.

About the report

The report was developed by WHO, the London School of Hygiene & Tropical Medicine and the South African Medical Research Council. It is the first systematic review and synthesis of the body of scientific data on the prevalence of two forms of violence against women – violence by an intimate partner and sexual violence by someone other than an intimate partner. It shows for the first time, aggregated global and regional prevalence estimates of these two forms of violence, generated using population data from all over the world that have been compiled in a systematic way. The report documents the effects of violence on women’s physical, mental, sexual and reproductive health. This was based on systematic reviews looking at data on the association between the different forms of violence considered and specific health outcomes.

Regional data

The report represents data regionally according to WHO regions.

For intimate partner violence, the type of violence against women for which more data were available, the worst affected regions were:

  • South-East Asia - 37.7% prevalence. Based on aggregated data from Bangladesh, Timor-Leste (East Timor), India, Myanmar, Sri Lanka, Thailand.
  • Eastern Mediterranean - 37% prevalence. Based on aggregated data from Egypt, Iran, Iraq, Jordan, Palestine.
  • Africa – 36.6% prevalence. Based on aggregated data from Botswana, Cameroon, Democratic Republic of Congo, Ethiopia, Kenya, Lesotho, Liberia, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia, Zimbabwe.

For combined intimate partner and non-partner sexual violence or both among all women of 15 years or older, prevalence rates were as follows:

  • Africa – 45.6%
  • Americas – 36.1%
  • Eastern Mediterranean – 36.4%* (No data were available for non-partner sexual violence in this region)
  • Europe – 27.2%
  • South-East Asia – 40.2%
  • Western Pacific – 27.9%
  • High income countries – 32.7%

For more information please contact:

Keletso Ratsela
South African Medical Research Council
Telephone: +27 12 339 8500, +27 82 804 8883

Fadéla Chaib
Telephone: +41 22 791 3228
Mobile: +41 79 475 5556

Jenny Orton/Katie Steels
London School of Hygiene & Tropical Medicine
Telephone: +44 (0)20 7927 2802

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Intimate Partner Violence Associated with Subsequent HIV Infection in Uganda. 10/6/2013

Roger Pebody

 Ugandan women who have been subject to violence from a sexual partner are more likely than other women to go on to acquire HIV, according to a large, longitudinal study from the Rakai cohort, published in the May 15 issue of AIDS. Women who had experienced more severe forms of violence, more frequently, or over a longer period of time had greater risks of HIV infection.

Violence against women is a serious and common human rights and public health problem, which causes significant morbidity and mortality. 'Intimate partner violence' (IPV) is one form of violence and has been defined as "behaviour within an intimate relationship that causes physical, sexual, or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviours".

Several (but not all) cross-sectional studies have identified an association between intimate partner violence and HIV infection. However, these 'snapshot' studies are unable to tell us what comes first – the violence or the HIV.

More reliable are prospective, longitudinal studies and two such studies have previously been published. Data from a South African cohort found that experience of physical or sexual IPV increased the risk of HIV infection (incidence rate ratio 1.51). In a seven-country African cohort, physical or verbal IPV appeared to increase the risk of infection but this was not statistically significant (incidence risk ratio 1.69).

In order to better understand the possible role of intimate partner violence in women’s vulnerability to HIV, Dr Fiona Kouyoumdjian and colleagues examined a decade’s worth of data from a cohort in Rakai, Uganda. There were 10,252 female participants who took part in interviews on multiple occasions and were HIV negative at the first interview. On average, women stayed in the cohort for five and a half years.

Rakai is a rural district in Uganda and agriculture was the main occupation for the majority of participants. Half the cohort were under the age of 24 and two thirds had less than seven years of schooling. Only one-in-five participants had never been married.

Most of the women (58.9%) had experienced intimate partner violence (IPV) at least once in their lifetime. In the past year, 16.0% had experienced sexual IPV, 16.8% physical IPV and 22.4% verbal IPV. Women often suffered more than one form of violence.

Just under one-in-ten women became HIV positive while in the cohort. The HIV infection rate was higher for women who had ever experienced intimate partner violence than for women who had not experienced IPV.

After statistical adjustment, women who had ever experienced IPV had an incidence rate ratio of 1.55 (95% confidence interval 1.25-1.94). This is comparable to the results seen in the two previous prospective studies.

Similar statistically significant results were seen for ever experiencing each form of intimate partner violence (physical, sexual, verbal) as well as for experiencing some forms of IPV in the past year.

When IPV was recorded as being 'severe' rather than 'minor', the HIV risk tended to be greater (e.g. ever experiencing severe physical violence, 1.96 [95% CI 1.46-2.63]).

There was a stepwise relationship between the number of times a woman experienced intimate partner violence and her increased risk of HIV infection. For example, women who reported five or more IPV events while in the cohort had an incidence risk ratio of 1.82 (95% CI 1.06-3.10); women with more than 20 events had a risk ratio of 3.03 (95% CI 1.83-5.01).

The association between violence and HIV infection could not be explained by condom use or by partner numbers. When these factors were controlled for, the association remained the same.

The researchers calculated that the population attributable fraction of infections that are associated with IPV is 22.2%. In other words, if intimate partner violence could be eliminated, there would be 22% fewer HIV infections in this group of women.

What is the link between violence and HIV infection?

The Rakai data, as well as the previous studies, appear to identify an association between intimate partner violence and subsequent HIV infection. But what are the mechanisms that link these two events? How is it that violence raises the risk of infection?

One possible mechanism is that forced sex could cause physical trauma and so increase the risk of transmission. However, the finding that it is all forms of violence, and not just sexual violence, that are associated with infection suggests that this cannot be the sole mechanism.

Alternatively, the experience of intimate partner violence may have an impact on women’s ability to negotiate safer sex or willingness to have more risky sex, either with the perpetrator of violence or with other partners. However, the Rakai data on condom use and partner numbers do not support this.

Another possible explanation of the link is not that violence increases the risk of HIV, but that HIV increases the risk of violence. For example, a woman suffers violence after disclosing her HIV status to her partner.

Finally, perhaps men who are violent may be more likely to have HIV, because some norms of masculinity encourage both men's control of women using violence and their sexual risk-taking.

Whatever the explanation, women attending health services for HIV testing and counselling should be asked about intimate partner violence and referred to appropriate services, say the authors. Moreover, more should be done to prevent violence, "as a means of both stopping the psychological and physical consequences of IPV and potentially of preventing HIV".


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The Role of Faith in Family Planning 30/05/2013

Senior Religion Editor, The Huffington Post


And now for some facts about women's reproductive health.

Approximately 800 women a day die during pregnancy and childbirth. For every woman who dies, approximately 20 more experience infection, disability, or injuries. The rate of mortality and injury of women during pregnancy and childbirth varies hugely between women living rich countries and poor countries, with the bottom being Afghanistan where one in 11 women will dying during pregnancy and childbirth. One in three women are married by the age of 18, one in nine by the age of 15, meaning that we are not just talking about women, but often about young girls.

An estimated 200 million women want to delay or avoid pregnancy but don't use effective family planning and the demand is expected to rise 40 percent by 2025. Of the 210 million pregnancies occurring each year, nearly 33 million are unintended. These lead to approximately 21.6 million unsafe abortions, causing some 47,000 deaths annually.

I learned these challenging figures when I was invited to moderate a panel called Faith and Family Planning at the Women Deliver conference that is happening right now in Kuala Lumpur. The goal of the conference is to advocate for the health and well being of women and girls across the globe in all areas of society, but especially in the area of pregnancy and birth.

It is crucial to talk about the role religion can play in the effort to empower girls and women in the area of family planning -- especially given that close to 90 percent of all people alive adhere to some religious belief, and that in rural areas of many developing countries health care is provided by religious organizations, or not at all,

However, the role of religion in the reproductive lives of women is also fraught and touches on many of the flash points that religious communities are grappling with today. These include the problem of gender inequity -- specifically in leadership roles; the authority of science within the religious worldview; and the agency of individuals, especially women, to develop and exercise individual conscience as weighed against the often mandated expectations of the community.

There is no question that religious influence can often seem adverse to those of us who believe that women's reproductive health is a fundamental human right. But what is also true is that this is a question about which there is an active debate within religious communities and that there is no one religious point of view. It is also true that even the most conservative religious communities can play a part in improving the health of women and girls.

Speaking to a packed room at the Faith and Family Planning panel, Dr. Pauline Muchina, who is a theologian and works at UNAIDS, helped clarify the question that often plagues any conversation on religion and family planning. "Almost everybody believes in family planning," Dr. Muchina explained, "but what we argue about is the method."

For instance, the Catholic Church hierarchy believes in 'natural' family planning that will help the couple to avoid pregnancy, but does not believe in contraception devices or pills. (Although what the people in the pews believe is an entirely different matter).

Dr. Muchina admitted that faith communities have both empowered and undermined the power of women and girls and emphasized that we need to talk about human sexuality along with faith and family planning: "We are all created in the image of God and we know that sex is a gift from God, yet sex can be dangerous or fulfilling depending on access to information and health services and things like contraception and condoms."

"My primary concern is to save lives. God has give us knowledge and technology to improve our lives through science. Are we going to throw condoms out? We are resistant to science in questions of sexuality, but when you you have a heart attack you go to the operation room -- you are willing to accept science then."

The Christian ethicist Dr. David Gushee explained that the evangelical Christian community has both deficits and strengths to offer the effort for comprehensive family planning for women and girls. The strength is that in the Christian view every life is infinitely sacred -- and that includes the lives of women. However, that ethical framework has been used largely in opposition to abortion instead of empowering women. That said, Gushee informed the room that evangelicals are not against contraception per say, as long as they are used inside of marriage.

For Middle East women's right activist Dr. Wajeeha Al-Baharna, sharing decision about family planning between husband and wife is a fundamental place to start. Dr. Baharna, a Muslim, insisted that Islam says that women and men should have equal say in the size of their families and timing of having children.

While these positions might not seem radical to a secular mindset, even small advances in how religious communities view reproductive health issues can have huge positive effects on the lives of women and girls on the ground.

Perhaps nobody is better able to speak about this than Dr. Babatunde Osotimehin, the Executive Director of the United Nations Population Fund.

When I asked him about how faith is playing a positive role in his work at UNFPA, he told me a story that happened when he was running the HIV program in Niger. They started with a 10 percent knowledge base about HIV, everyone was in denial and they tried everything -- TV, radio, theatre, and the knowledge just wasn't coming up at all. Then he went up and spoke to the head of the Muslim community (about half of the population) who agreed to go on camera and talk about HIV and the results were dramatic. Suddenly everyone wanted to get involved.

Dr. Osotimehin explained:

"If you are to engage religious communities whether Muslim, Christian, Animist, you need to understand the context, and respect it. You know they have limits, they have red lines and you respect those red lines, but you work in the middle ground where you think you can make a difference. In UNFPA now, we have religious organizations that work with us because the work we do is not abstract, it is about saving women and girls's lives. There is no religious leader in the world that will tell me that they would rather have women and girls die."

When asked if the UNFPA also has 'red lines' in dealing with religious communities on matters of reproductive health Dr. Osotimehin told me:

"It's a matter of give and take. UNFPA works in more than 150 countries around the world. You can imagine the varying social and cultural context in each of those countries. And we have made some major progress in some of those places. In Niger the use of family planning was like 5 percent, we set up something called 'The Husband School' that had religious leaders, community leaders and civil servants -- all men. We took them through all the issues. In three years we increased the contraception use from 5 to 20 percent. And the Nigerien public is almost totally Muslim.


I can't think of any country where it is total pushback and we can't do anything. It's about navigating it. Our red line is that nobody will stop us from saving the next girl's life."


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Brothers For Life in the News13/05/13

Attached is a PDF version of the four page Brothers for Life section published in the Daily Sun of Monday 29 April 2013

It carries articles on;

  • Men must end the violence
  • You must work to improve your image
  • A declaration : Not in My Name!
  • Never Beat a Woman: An abuser tells his story
  • Power of Partnership increases the MMC service at Soshanguve
  • Get Circumsised: Know the Facts
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Gender Based Violence and HIV: 57th Commission on the Status of Women 25/03/2013

Published by the Aidsconsortium

The UK Consortium welcomes the consensus reached on agreed conclusions of the 57th Commission on the Status of Women (CSW). After the impasse of last year that resulted in no agreed outcome document, it is encouraging that member states have come together on the serious issues of violence against women and women’s role in HIV caregiving.

The Commission notes that “violence against women and girls is rooted in historical and structural inequality in power relations between women and men, and persists in every country in the world as a pervasive violation of the enjoyment of human rights”, acknowledging that violence against women occurs in both public and private settings.

We are particularly encouraged to see strong recognition in the agreed conclusions of the many links between violence against women, HIV and AIDS, as well as the impact violence has more broadly on sexual and reproductive health. Research shows that intimate partner violence (IPV) doubles women’s vulnerability to acquiring HIV and that gender based violence and rape more generally are co-epidemics in countries with high burdens of HIV.

The Commission calls for the elimination of discrimination and violence against women and girls living with HIV as well as the caregivers of persons living with HIV. It also backs the acceleration of efforts to address the intersection of HIV and AIDS and violence against women and girls. But how to do this? The Commission recommends strategies to address domestic and sexual violence, the strengthening of coordination and integration of policies, programmes and services to address the intersection between HIV and violence against women and girls, and by ensuring access to HIV diagnostics, affordable and accessible treatment and prevention services.

We agree with the Commission’s stance that barriers to affordable and accessible health care services, including HIV, sexual and reproductive health, must be overcome if women are to live a full and healthy live. It is also encouraging to see that the Commission agrees to promote and protect the right of all women to have control over, and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health and access to HIV services – free of coercion, discrimination and violence. The Commission also urges Governments to take action to prevent violence against women and girls in health care settings, especially for vulnerable women and girls including those living with HIV.

We welcome the Commission’s re-focus on education as a human right, ensuring girls attend school as a lever for empowering women, reducing violence, and in addition lowering risk of HIV transmission (research shows that girls who have a secondary education are three times less likely to be living with HIV).

We agree with the Commission that men and boys must be engaged if we are to end violence against women, but caution against diverting funds from women-led organisations for this purpose. Globally many small organisations deeply committed and connected to these issues are struggling and folding over the last several years. As research from the Population Council has shown, funding to programmes led by women’s organisations spreads the beneficial outcome to men and boys also, whereas funding to men’s programmes tends to be spent more exclusively on men and boys.

The UK Consortium recognises that caregivers provide an essential HIV care and support role, without which the successes we have had in the response to HIV and AIDS would not have been achieved. Caregivers are predominately female with gender norms and stereotyping reinforcing the notion that caregiving is “women’s work”. We welcome the Commission’s call for the sharing of paid and unpaid work between women and men, as well as the need for gender-sensitive policies and programmes which promote greater understanding and recognition that caregiving is a critical societal function (and thus equal sharing of responsibilities and chores between men and women in caregiving). The Commission urges Governments to work to change attitudes that reinforce the division of labour based on gender in order to promote shared family responsibility for work in the home and reduce the domestic work burden for women and girls (allowing girls to attend school).

DFID Minister Lynne Featherstone attended the CSW, building on their leadership on women and girls rights by announcing investment in pushing for the end of female genital mutilation (FGM) worldwide within a generation. This builds on commitments made by Justine Greening on International Women’s Day which seeks to strengthen DFID work on gender inequality.

It is encouraging to see the link between HIV and violence acknowledged and whilst the Commission “strongly condemns” violence against women and girls, re-affirms the many resolutions, conventions and declarations focused on gender based violence, and “urges” Governments to strengthen legal and policy frameworks, it remains to be seen if this will change the lives of women throughout the world, including women living with HIV, who suffer violence as a part of their daily lives. Now we need to turn promises into action.


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Ending Violence Against Women: Start Young Before It's Too Late. 15/03/2013

Submitted by Ravi Verma on Friday, March 15, 2013

ICRW's Ravi Verma explains why engaging young men and boys is essential

ICRW was one of 30 civil society organizations selected to address the 57th Commission on the Status of Women at UN headquarters in New York last week. ICRW’s Asia Regional Director Ravi Verma travelled from his home base in New Delhi to make the following presentation on the importance of working with young men and boys to eradicate violence against women and girls:

I want us to think about why we are here today. Why are you here?  I am here today because of the horrific gang rape and consequent death of a twenty-three year-old girl in my city, Delhi, in my country, India. I am also here today because I am a man who cares.  I am a man who is standing strong for gender equality, calling for the end of violence.

Days before the attack on that Delhi bus, my colleagues and I at the International Center for Research on Women concluded a study that found that 95% of women do not feel safe in public spaces of Delhi. 75% said they had faced sexual aggression or violence in their own neighborhoods. Nine out of 10 reported ever experiencing violent acts in public spaces during their lifetime, with these experiences ranging from obscene comments to being groped, stalked or sexually assaulted. Six out of 10 women reported sexual aggression or violence in the six months preceding the survey.

Data from around the world document that an epidemic of violence against women and girls exists.  Findings from ICRW’s survey in Delhi also depict a complex story about what it means to be a man in a strongly patriarchal society.  Half of the men surveyed in Delhi reported having sexually harassed or perpetrating violence against women. 78% had witnessed such aggression or violence in public spaces, but only 15% had intervened. As you may imagine, the reasons for not intervening are diverse and include fear of retaliation.

If we are to eradicate violence against women and girls, then we must recognize that from an early age boys are socialized to adopt prevailing attitudes about gender and are taught how to be men. In other words, men and boys face enormous social pressure to conform to ideals of manhood and to express that ideal in relation to each other and towards women and girls. We could go so far as to say that men and boys often experience violence when not adhering to society’s norms and expectations around masculinity. 

Speaking as a man, I can tell you that the task of becoming a ‘real man’ is daunting.  Failure is not acceptable and retribution is often harsh. Evidence from a six-country study on attitudes toward gender equality conducted by ICRW and Instituto Promundo show that in most cases men are perpetuating violent behaviors they learned as children, perhaps by witnessing violence against their own mother.  Men and boys are not born violent, but are made to be what they are – aggressive, intolerant, controlling.  And they demonstrate these aggressive behaviors across many settings: households, schools, sports fields and even city streets.

While the situation of violence against women and girls is dire, promising solutions are being developed as we speak.  At ICRW we have been working in a large number of public schools in Mumbai testing a gender equality curriculum for middle school students, boys and girls aged 10 to 12. 

At the end of our three study, our evidence shows that carefully directed discussions with students about gender, gender roles and expressions of masculinity over the course of time help transform attitudes on gender equality.  This is particularly true when students are engaged in concrete activities, like a student-led campaign to end violence.  These active, engaging strategies are more effective in reducing tolerance for violence than programs that merely mention violence prevention as an important practice.

Here are the critical lessons: Allow time for attitude change; behavior change will follow. Start young, before a lifetime of attitudes are fully assimilated and harmful behaviors become a lifetime of practice.  Engage boys and girls, men and women, to create comprehensive and sustainable solutions to end violence against women and girl.

Gang rape is not unique to my city, nor to my country.  This is a silent epidemic that has taken too many lives.  As a people, we must critically reflect on violence and manhood and cast gender equality and positive expressions of masculinity as a public good.  As a people, we must radically transform the harmful social norms that underpin this violent epidemic so we may, as a people, create a more equitable, peaceful and just world. I am here today because I stand with you in that quest.

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A Call to South Africans to Recover our Humanity 09/02/2013

Michael Lapsley

Anene Booysen is a name on the lips of almost every South African this week. She has become the visible image of a deathly scourge that haunts us all – the scourge of rape. As happens more and more frequently, Anene’s rape was accompanied by extraordinary levels of violence.

Anene has been robbed of her life. Her mother has been robbed of a child. But it is not only Anene who has died brutally this week. The hope of our rainbow nation dies, agonising cry by agonising cry, every time a woman is raped - approximately 3500 times a day. How is it that the dream nation has become the rape capital of the world?

Next Wednesday is Ash Wednesday, the first day of Lent in the Christian calendar. Lent is a time of repentance and fasting. Leaders in the Anglican Church of Southern Africa (ACSA) have called on all members of the Church to use the season of Lent to recognise that every time we fail to act against gender based violence, we are complicit in its perpetration. Anglican churches are being requested to light a candle on Wednesday in memory of Anene and all women who have suffered the violence of rape. Male members are being asked to declare “not in my name. This violence may not continue.”

All Clergy are being asked to address the issue of rape and to invite members of their congregations to seek ways together for all of us to end this moral sickness and recover our humanity.

ACSA is also calling upon

• the government to formulate and implement a national strategy ; and

• the police and justice system to bring the perpetrators of Anene’s rape and death to justice.

Christians affirm that human beings are made in the image and likeness of God. Each human being who is raped by our violence, left to die by our lack of compassion, grieves the heart of God. For the sake of the memory of Anene, for the sake of her mother Corlia Olivier, for the sake of our humanity, let us stop this deathly illness in our society.

Issued by Bishop Rubin Phillip, Dean of the Anglican Church of Southern Africa

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Gender News 2012

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The Global AIDS Response Must Have a Woman's Shape. 3/12/2012

Mary Hastings, This is Africa

"Some of the most promising solutions to the spread of HIV reside in stripping away the layers of oppression from the lives of women and girls."

Gender inequality is HIV's best friend. Fortunately, the converse is also true – gender equality is HIV's nemesis. And by fighting HIV through advancement of gender equality, we reap all kinds of additional benefits.

Women account for slightly more than half of all people living with HIV, and the majority contract it through sex with long-term partners.

Young women account for nearly 75 percent of infections among people ages 15-24 in sub-Saharan Africa. Girls who bear the brunt of two classic symptoms of gender oppression - being married off young or kept out of school - are particularly vulnerable to HIV.

Gender violence – whether it's rape used as a weapon of war, physical violence in the home that takes away women's power to suggest condom use, or emotional violence that keeps women silent and untreated if they are diagnosed with HIV – is like gasoline to the spread of HIV.

Some of the most promising solutions to the spread of HIV reside in stripping away the layers of oppression from the lives of women and girls. Access to comprehensive, rights-based sexual and reproductive health services is a critical first step.

Such care allows a woman to control the number and spacing of her children, and to confidentially test her HIV status. It gives her tools to protect herself – tools like female condoms, effective in preventing both HIV and unintended pregnancy.

And such care gives her the ability to stay healthy during pregnancy and childbirth, regardless of her HIV status. By linking these services together and infusing them with a respect for the dignity of each woman and girl, we greatly improve the likelihood that she will benefit from the highest attainable standard of health care.

Efforts beyond the formal health sector also present possibilities.

Programs such as microfinance and cash transfers that bolster economic opportunity and educational access for women and girls are proven to reduce their risk for HIV.

Outreach to men and boys, to combat gender violence and change gender norms, is also creating impact. Weakening HIV's grip on women and girls by improving their legal, social, and economic status is absolutely essential.

If we fail to understand how deeply HIV's roots are intertwined with the violation of women's rights we may end up winning battles but we are certainly losing the war. The woman living with HIV who is mistreated by health care providers is unlikely to seek tools to prevent a pregnancy, or care during a pregnancy.

Condom promotion is useless where violence takes away a woman's right to protect herself. Maternity wards that put multiple women in each bed and lack basic life-saving supplies help drive women to give birth at home – endangering their lives and leaving them untested for HIV.

The global AIDS response must promote:

Women's rights: HIV depends on gender inequalities that prevent women from supporting themselves financially and making decisions about their sexual activity. Women's rights need to be recognized, respected, and promoted if we are going to end HIV.

Women's participation: The clearest way to ensure that policies and programs are advancing gender equality is to includewomen in decision making.  Living these realities, they are best equipped to pinpoint what meets their needs. There are women's rights groups in every country on the planet, and we cannot accept any more excuses for not including women at the table.

Woman-controlled prevention: We have to increase funding and policy support for female condoms, in additional to male condoms. They must be a mandatory component of all programs that prevent and treat HIV.

Integration of sexual and reproductive health: HIV, family planning, and maternal health are intrinsically linked, and services need to reflect that.

Gender equality is AIDS' nemesis. We cannot create an AIDS-free generation without it.

Mary Beth Hastings is vice president, Center for Health and Gender Equity

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No Stop to HIV Infections Unless Gender Violence Addressed. 26/11/2012

Cape Town – Zero HIV infection rates will never be achieved unless tackling gender-based violence is part of addressing the epidemic, an expert told HIV specialists, researchers and nurses, meeting at the first Southern African HIV Clinicians Society conference.

Anso Thom

 Professor Rachel Jewkes of the Medical Research Council, an international expert on gender-based violence, revealed that incidents of intimate partner violence, sexual abuse as children and sexual violence as adults (rape), massively increased the incidence of HIV infection, especially among women.

A study led by Jewkes found that almost 40 percent of adolescents from the rural Eastern Cape had been sexually abused as children.

“Dealing with this type of violence, is a normal feature of clinical case loads,” said Jewkes, who stressed on several occasions that in her opinion the incidence of violence was hugely under represented in South Africa.

Jewkes added that there was a clear correlation between partner violence and an increased incidence of HIV. One of her studies found that around 12 percent of HIV cases among women could be attributed to more than one case of intimate partner violence. Around 14 percent of HIV cases among women could be attributed to very low power in the relationship as it meant the woman was unable to negotiate condom use or confront her partner if she suspected he was unfaithful.

“A very high percentage of HIV can be attributed to gender based violence,” said Jewkes, expressing dismay over the fact that UNAIDS had relegated it to a “situational factor” in the epidemic.

“It flies in the face of everything we know,” she added.

Jewkes said it was also time to talk about so-called “love seeking behavior” as she believed many children who experience emotional abuse are at higher risk later.

“We need to talk about the dangers they are willing to undertake as part of love seeking or the willingness to hold onto someone who is bad for them, as part of this love seeking behavior,” she said.

Jewkes added that a high number of HIV cases could also be attributed to people who show signs of being psychologically distressed. This includes people suffering from chronic anxiety, depression, post-traumatic stress disorder and substance abuse problems.

In closing, Jewkes said the evidence showed that when thinking about the role of men it was time to work out how to change their masculinities as opposed to their behavior.

The conference continues until Wednesday.

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Multi-Pronged Approach Needed to Reduce Gender-Based Violence. 2511/2012

Gender Links

Patriarchal norms and attitudes including those that excuse or legitimate the use of violence are driving the alarming rates of gender based violence (GBV) in South Africa. This is one of the topline findings of the GBV indicators research carried out in Gauteng, Limpopo, KwaZulu Natal and Western Cape provinces of South Africa (SA) by Gender Links (GL) between 2010 and 2012. The research measures the extent, effects, response and prevention of violence against women perpetrated by men.

As the 2012 Sixteen Days Campaign kicks off, GL urges the Department of Women, Children and People with Disabilities (DWCPD) to launch and allocate a substantive budget for the proposed National GBV Council. GL further urges the government to cascade the research to the remaining five provinces of South Africa, to establish a national baseline against which to measure progress towards the attainment of the Southern African Development Community (SADC) target of halving GBV by 2015.

Seventy seven percent of women in Limpopo, 51% of women in Gauteng, 45% of women in Western Cape and 36% of women in KwaZulu Natal have experienced some form of violence (emotional, economic, physical or sexual) in their lifetime both within and outside intimate relationships.

A higher proportion of men in Gauteng (76%) and KwaZulu Natal (41%) admitted to perpetrating violence against women in their lifetime. A slightly lower proportion of men, compared to the proportion of women reporting GBV said they perpetrated GBV in Limpopo (48%) and Western Cape (35%). Comparing what women say they experience to what men say they do confirms that gender violence is a reality in SA.

The majority of violence reported occurred within womenand men's private lives. Fifty one percent of ever-partnered women in Gauteng, 51% of women in Limpopo, 44% of women in Western Cape and 29% of women in KwaZulu Natal reported experiencing intimate partner violence (IPV) in their lifetime. The low prevalence of GBV reported by women in KwaZulu Natal is indicative of an even bigger problem that women may not be openly disclosing their experiences.

However, women are also vulnerable to violence in public life. Twelve percent of women in Gauteng; 6% of women in Western Cape; 5% of women in Limpopo and 5% of women in KwaZulu Natal reported experiencing non-partner rape in their lifetime. The proportion of men reporting rape perpetration in the four provinces is significantly higher than the proportion of women reporting experience.In Gauteng, 31% of men admitted to have raped a woman at least once in their lifetime.

Over half (59%) of women in Limpopo, 5% of women in KwaZulu Natal, 5% of women in Western Cape and 2.7% of women in Gauteng who had ever worked reported being sexually harassed. They disclosed that a man either hinted or threatened that they would lose their job if they did not have sex with him; or they would have to have sex with him in order to get a job.

Almost two thirds (65.9%) of women in Limpopo, 2% of women in KwaZulu Natal, 1.4% of women in Gauteng and 1.2% of women in Western Cape who had attended school said the experienced sexual harassment at school.The extremely high prevalence of sexual harassment in the workplace and at school in Limpopo province warrants further research.

The Limpopo research shows that women in the province suffer from GBV related to witch-hunting. This occurs when communities blame deaths, or sicknesses or other misfortunes in their community on witchcraft. Women constitute the vast majority of witchcraft. Those accused experience multiple effects including emotional, trauma, injury, being forced to leave home or relocate and loss or damage to property. Communities continue to unite in plans to exterminate women suspected of witchcraft.

In the Western Cape, the research shows that women are being forced or initiated into drug intake by their intimate partners. At times, drug intake becomes an effect as abused women attempt to escape the trauma that comes with gender violence. In KwaZulu Natal, women are not speaking out about gender violence. Generally literacy levels are low thus knowledge on the forms of abuse, women's rights and where to get help barely reaches these women. They actually uphold and affirm patriarchy.

The research shows that reactionary attitudes and beliefs in communities fuel the incidences of GBV. High proportions of women and men agreed that a woman should obey her husband. However, the proportion of women agreeing to the notion of wife obedience in each of the sites is lower than men's, showing that women are slightly more progressive than men

The indicators research findings provide invaluable evidence required to review the 365 Day South African National Action Plan to End GBV. A report released by the Commission on Gender Equality last week found that government efforts towards implementing the plan have been fragmented and lacked a dedicated budget.

Activists are urging that the long-delayed National GBVCouncil, to be chaired by Deputy President KgalemaMotlanthe, be announced during the Sixteen Days. The high level, multi-sector Council is modeled on the South African National AIDS Council.

GL is also calling on local government needs to allocate financial resources for context specific prevention and awareness raising initiatives using the findings from the indicators research. Advocacy programmes must be targeted at changing women's and men's attitudes towards gender relations. Engaging men and youth in the fight to reduce levels of gender based violence cannot be underrated.

To view The War @ home: Findings of the Gender Based Violence Prevalence Study in Gauteng, Western Cape, KwaZulu Natal and Limpopo Provinces of South Africa, For more information call Mercilene Machisa on 00 27 11 622 2877 or email

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The (Re)making of Men. 7/09/2012

Negative coverage of men is doing more harm than good.

Photo: USAID
Brothers for Life

JOHANNESBURG, 7 September 2012 (PlusNews) - Manhood might be hard to define but South African media make it even harder, according to editors of a new book, who argue that negative coverage of men is doing more harm than good, especially when it comes to HIV. Now they are looking to rewrite masculinity in a country that ranks among the most gender inequitable in the world.

(Un)covering Men: Rewriting Masculinity and Health in South Africa is a compilation of works by journalism fellows through Anova Health Institute’s HIV and Media Project, originally the brainchild of noted South African journalist Anton Harber and HIV researcher and programme implementer Helen Struthers, who co-edited the book.

The book’s other co-editor, Melissa Meyers, characterized the 211-page book as a bid to combat stereotypes of men perpetuated by the media and to create a more nuanced portrayal of men by telling stories around issues such as fatherhood, men-who-have-sex-with-men (MSM) and traditional male circumcision.

“Writing about different kinds of men involves looking at all these different stereotypes or men - men as Lotharios, as risk-seekers, as domineering,” she told IRIN/PlusNews. “By contrasting these stories, we were able to show that the current media engagement with men and notions of masculinities is disturbingly shallow.”

“We’ve looked at how that might affect health-seeking behaviours,” said Meyers, who also coordinates the HIV and AIDS Media Project for Anova. “So we’ve taken that conversation and put it in the context of the most pressing health concern in this country and one that’s most linked to ideas of masculinity - HIV.”

South Africa continues to battle high levels of gender inequality, ranking in the bottom half of all countries surveyed in the 2011 United Nations Development Programmes’ Gender Inequality Index. In 2009, a study by South Africa’s Medical Research Council (MRC) made international headlines after it found that one in four South African men surveyed admitted to having raped a woman in their lives.

Using the same data set, researchers also revealed last year that about 10 percent of South African men had experienced sexual violence at the hands of another man. The overwhelming majority of men who reported sexually abusing another man also reported being violent towards their female partners - an HIV risk factor for women in a country where HIV prevalence is about 12 percent.

Looking at the man in the mirror

Statistics like this may contribute to men’s bad rap, but stereotypes portrayed in the media are hurting those working to change men’s bad behaviour, according to Mandla Ndlovu, who works for Johns Hopkins Health and Education in South Africa.

To combat high levels of gender-based violence, John Hopkins launched its Brothers for Life programme in 2009. Designed to re-enforce positive gender norms, the programme set about trying to promote positive male role models, but Ndlovu admits it was hard in the beginning,

“It was difficult to find materials to use at the start of Brothers for Life,” Ndlovu told IRIN/PlusNews. “You were always finding resources that pointed a finger at men instead of telling us what made them tick.”

''A father is seen as a provider. He leads the family. He's 'the man' ... When your father is HIV-positive and dying, when he cannot provide for the family, it destroys (some) families completely''

“I’ll be the first to admit a lot of our social ills can really be [tied to] how masculinities have been framed - a man is the boss, what a man should be,” he added. “But it’s important if we want to solve the same social ills that we talk to the very same men and walk with them in their journey.”

Thabisile Dlamini, a journalist, actor and author, wrote about HIV and fatherhood - a topic close to her heart after the loss of her own father to AIDS-related illnesses in 2008. At 20 years old, Dlamini was left to care for her younger siblings.

“A father is seen as a provider. He leads the family. He’s ‘the man,’” she said. “When your father is HIV-positive and dying, when he cannot provide for the family, it destroys (some) families completely.”

“I remember interviewing one family where the father was HIV-positive and had had a stroke so he was disabled. He couldn’t work anymore,” she said. “There were issues of resentment there. I remember sitting down with a father and daughter, and we actually had to postpone the meeting because tensions were so high.”

But Dlamini said she also saw some men’s HIV-positive diagnosis bring families together as they rallied to support fathers or as fathers looked back on their lives as absentee dads and were moved to rekindle bonds with their children.

What’s left unsaid

Pieter van Zyl, a senior writer for South African media house Media24's family magazines, used the opportunity to write about gay men and MSM. He spent three weeks in Cape Town's Guglethu township interviewing MSM and gay men in 2009.

He produced five stories about issues faced by MSM such as discordance, disclosure, and balancing marriages to women with desires to be with men.

The book provides an outlet for some of the stories South African outlets would not run. More than a year after the stories were written, four of the six stories remain unpublished, even by van Zyl's own Media24 Afrikaans-language magazine, which van Zyl said has a large gay readership.

According to van Zyl, while he found resistance to the stories' same-sex subject matter among mainstream media houses, outlets within the gay community were also reluctant to run HIV-related copy they saw as 'depressing.'

Finally for some contributors, such as clinical psychologist Mthetho Tshemese, the work he explored regarding sexuality, masculinity and traditional male circumcision within his Xhosa culture has cemented his interested in working with young men.

He’s started a programme at his former high school in South Africa’s Eastern Cape Province to talk to young men about sex, sexuality and HIV prevention.

“I want them to have the space to reflect on the kind of masculinities they want to embrace,” he told IRIN/PlusNews. “There comes a time, even though we embrace rituals about who we are, [when] we have to start thinking about that that means for us as individuals because all the things we do as men, we do mostly in our individual spaces.”

Theme (s): Gender Issues, HIV/AIDS (PlusNews),

[This report does not necessarily reflect the views of the United Nations]

 Copyright © IRIN 2012. All rights reserved. This material comes to you via IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or its Member States. The boundaries, names and designations used on maps on this site and links to external sites do not imply official endorsement or acceptance by the UN. Republication is subject to terms and conditions as set out in the IRIN copyright page.

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New Prevention Technologies in HIV: What Would They Mean for Women? 9/2012

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 New Prevention Technologies in HIV: What Would They Mean for Women?

Summer 2012

Biomedical tools for HIV prevention, also known as new prevention technologies (or NPTs), are often touted as tools that will give women greater control over HIV prevention. But will these tools actually empower women? Here, we explore this question and some reasons for optimism and skepticism.

Women Are More Vulnerable to HIV

In Canada and around the world, many women are at a disadvantage socially and economically. These disadvantages mean that women are often at risk of HIV infection because they lack the power to negotiate the use of HIV prevention measures, such as condoms, abstinence and mutual monogamy. In addition, all women are biologically more susceptible to HIV infection through heterosexual sex than men for several reasons. Firstly, women are exposed to more HIV during sex than men because the volume of semen is usually greater than the volume of vaginal fluid and because semen contains a higher concentration of HIV. Secondly, more of a woman's mucous membranes are exposed to HIV because the surface area of the vagina is greater than that of the penis. Finally, HIV has more time to cause infection in women because semen can remain in prolonged contact with the vagina following unprotected sex.1,2

"Abstinence and condom use may be impossible for women to enforce. Fidelity is of no use unless it is mutual, and men's faithfulness very often lies outside of women's control."3

Expanding the HIV Prevention Toolkit

Efforts are underway to develop several new technologies to prevent HIV, including microbicides, vaccines, post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP) and HIV treatment as prevention. In recent trials, some of these NPTs have proven successful.

These new technologies may have the ability to expand the HIV prevention toolkit, giving women more options to protect themselves from HIV. When thinking about the potential value of NPTs, a helpful analogy is the range of contraception options available to women (see figure). Currently available contraceptive options are considerable and each woman can choose a method based on her personal needs and preferences. Similarly, potential new HIV prevention options would greatly expand women's options for HIV prevention and provide a range of timing options (before, during or after sex) and modes of use (oral, topical or injectable), thus allowing each woman to choose the right option for her.


Contraception and HIV Prevention

Just as women have very different preferences for birth control, women would also have options for preventing HIV transmission. In other words, the more options to choose from, the better, because there will never be a "one-size-fits-all" option that is acceptable to all women.

The Potential for Women's Empowerment

Will these new NPTs increase women's control over HIV prevention?

Reasons for Optimism

One of the main arguments for the potential of NPTs to provide women with more control over HIV prevention is that women could use NPTs without the consent or even the knowledge of their male partners (this is sometimes called covert use). Therefore, NPTs may help women who experience problems negotiating safer sex and are less empowered to insist on condom usage -- such as women who do commercial sex work and women in coercive relationships.4 While NPTs such as PrEP and microbicides are not likely to provide the same amount of protection as condoms, some protection is better than none in cases where the male partner refuses to use a condom.5

Also, unlike condoms, many NPTs would not have to be used in "the heat of the moment" and therefore may make negotiating safer sex easier for women. Biomedical research is shifting from focusing on prevention methods that need to be used at the time of the sexual encounter to methods that can be used before and/or after sex.6 It may be easier for women to negotiate these methods than to convince a male partner to use a condom during each and every sexual encounter.

Another key benefit of NPTs for women is that they could allow women to conceive while at the same time protecting against HIV infection. The primary HIV prevention method currently available -- condoms -- does not allow for safer conception between serodiscordant couples (where one is HIV positive and one is HIV negative). Developing HIV prevention tools that would allow for conception while still reducing the risk of HIV infection would have a significant advantage for serodiscordant couples wanting to have a child.

Prevention methods such as condoms and abstinence are not always realistic options for women, especially those who are married, who want to have children or who are at risk of sexual violence. A safe and effective microbicide, PrEP or HIV vaccine could provide women with more options for protecting themselves from HIV infection.

Reasons for Skepticism

While there are reasons for optimism, NPTs may not be the panacea for women's equality and empowerment that they are sometimes thought to be.

Even if NPTs become available and even though the use of NPTs would technically be under a woman's control, it may not be possible for many women to use an NPT.6,7 Whether a woman decides to use an NPT is a complex process.8 Her decision will be based on several factors: Does she think she is at risk of HIV infection from her partner? Does she understand how the NPT works? Can she afford the NPT? What does she anticipate her partner's reaction to be? Does she have enough autonomy to make her own decisions about her sexual and reproductive health? Finally, some studies have shown that, just as with condoms, many women are unlikely to use NPTs with their regular partners. The reasons given include the perception that an NPT could reduce their own or their partner's pleasure and the concern that their partner may interpret NPT use as a sign of mistrust.8-10

Although NPTs could theoretically provide women with more control over HIV prevention and allow women to use prevention methods discreetly, the use of some NPTs may not be all that easy to hide. For example, an attentive male partner might notice the extra lubrication or a different sensation from a microbicide, or find his partner's stash of PrEP pills. In some cases, if women are discovered using prevention products, they could face adverse consequences, even violence, as the products might be seen as an affront to men's power and the traditional gender norms.9,11,12 So, although NPTs could offer women more choices, there is no guarantee that they will empower women.

A woman may also face negative consequences if she does decide to negotiate NPT use with her partner. For example, broaching the topic of NPTs with their male partners might signify mistrust and/or infidelity.12,13 Also, if women tell their male partners about their use of an NPT, men may decide that they no longer have to use condoms, which could increase women's risk of HIV transmission since NPTs are not as effective as condoms.8,10 This effect is known as risk compensation.

NPTs could also further entrench women's responsibility for sexual health, rather than promoting a shared responsibility. Women are already primarily responsible for birth control, and NPTs could add to the burden on women to make sex "consequence-free" for their male partners.8

A lot can be learned from our experience with the female condom, which is currently the only female-initiated prevention tool currently available.14 Although touted as a tool that would empower women, the female condom has generally not lived up to its expectations for various reasons including difficulties with covert use, poor acceptability among some women, and its relatively high cost.

Key Messages That We Can All Get Behind

When discussing the value of NPTs, we need to avoid over-simplifications of their (potential) link to "women's empowerment." Although NPTs may empower some women in some situations, they won't bring about universal sexual empowerment.

NPTs should not be seen as a "quick fix" solution nor should they distract attention from the need for social change and multi-level interventions that address gender inequality, poverty, and other forms of discrimination that make women more vulnerable.8,10 It is clear that NPTs will not have an impact unless the underlying social, economic, political and cultural conditions that make women more vulnerable in the first place are tackled. Addressing these conditions will also help remove the barriers that prevent women from using these new prevention options.

Therefore, NPTs must be offered within a comprehensive approach to HIV prevention -- one that balances structural changes (such as poverty reduction and gender equality), expanding and strengthening existing prevention strategies (such as behavioural interventions and the distribution of male and female condoms) and NPTs (such as PrEP and microbicides).

Frontline service providers and policy-makers need to understand the potential gender dynamics that will influence if and how women will use NPTs as they become available. Clearly, biomedical tools cannot replace women's sexual and reproductive autonomy, but they could provide the means by which women exercise such autonomy.


San Patten is a health research and evaluation consultant who has worked extensively on issues relating to injection drug use, the sex trade, and new HIV prevention technologies. San completed a master's degree in Community Health Sciences at the University of Calgary, is an adjunct professor in Sociology at Mount Allison University (specializing in social policy and non-profit leadership), and is a co-investigator of the Centre for HIV Prevention Social Research at the University of Toronto.


  1. O'Brien TR, Busch MP, Donegan E et al. Heterosexual transmission of human immunodeficiency virus type 1 from transfusion recipients to their sex partners. Journal of Acquired Immune Deficiency Syndromes. 1994; 7(7):705-710.
  2. European Study Group on Heterosexual Transmission of HIV. Comparison of female to male and male to female transmission of HIV in 563 stable couples. BMJ. 1992 Mar 28; 304(6830):809-13.
  3. Dunkle KL, Jewkes R. Effective HIV prevention requires gender-transformative work with men. Sexually Transmitted Infections. 2007 Jun;83(3):173-4.
  4. Youle M., Wainberg MA. Pre-exposure chemoprophylaxis (PrEP) as an HIV prevention strategy. Journal of the International Association of Physicians in AIDS Care (Chicago, Ill: 2002). Jul-Sep;2(3):102-5.
  5. PrEP Implementation Policy Forum: Developing Country-Level Participation and Capacity for PrEP Implementation [Internet]. Geneva: International AIDS Society; 2007 [cited 2010 Feb 5].
  6. Sawires S, Birnbaum N, Abu-Raddad L, Szekeres G, Gayle J. Twenty-five years of HIV: lessons for low prevalence scenarios. Journal of Acquired Immune Deficiency Syndromes. 2009;51(Suppl 3):S75-S82.
  7. Koo HP, Woodsong C, Dalberth BT et al. Context of acceptability of topical microbicides: sexual relationships. Journal of Social Issues. 2005;61(1):67-93.
  8. Mantell JE, Stein ZA, Susser I. Women in the time of AIDS: barriers, bargains, and benefits. AIDS Education and Prevention. 2008 Apr;20(2),91-106.
  9. Hoffman S, Morrow KM, Mantell JE et al. Covert use, vaginal lubrication, and sexual pleasure: a qualitative study of urban U.S. women in a vaginal microbicide clinical trial. Archives of Sexual Behavior. 2010 Jun; 39(3):748-60. Epub 2009 Jul 28.
  10. Mantell JE, Dworkin SL, Exner TM et al. The promises and limitations of female-initiated methods of HIV/STI protection. Social Science and Medicine. 2006 Oct;63(8):1998-2009. Epub 2006 Jul 11.
  11. Tolley EE, Severy LJ. Integrating behavioral and social science research into microbicide clinical trials: challenges and opportunities. American Journal of Public Health. 2006 Jan;96(1):79-83. Epub 2005 Nov 29.
  12. Tanner AE, Fortenberry JD, Zimet GD et al. Young women's use of a microbicide surrogate: the complex influence of relationship characteristics and perceived male partners' evaluations. Archives of Sexual Behavior. 2010 Jun; 39(3):735-47. Epub 2009 Feb 18.
  13. Woodsong C. Covert use of topical microbicides: implications for acceptability and use. Perspectives on Sexual and Reproductive Health. 2004 May-June;36(3):127-131.
  14. UNAIDS. UNAIDS Report on the global AIDS epidemic. 2010.

This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication Prevention in Focus: Spotlight on Programming and Research. You can find this article online by typing this address into your Web browser:

General Disclaimer: The Body PRO is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through The Body PRO should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.

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No Definitive Link Between Hormonal Contraceptives and Increased Risk of HIV Infection Among Women, CDC Says. 22/6/12

The evidence does not suggest a link between oral contraceptives such as the birth control pill and increased HIV risk

June 22, 2012

"There is no clear link between the use of contraceptives such as the birth control pill or Depo-Provera shots and an increased risk that a woman will contract HIV, the U.S. Centers for Disease Control and Prevention said on Thursday," Reuters reports, noting that the WHO came to the same conclusion in February. Following a review of recent studies suggesting women taking hormonal contraceptives might be at an increased risk of HIV infection, "the Atlanta-based CDC said, 'the evidence does not suggest' a link between oral contraceptives such as the birth control pill and increased HIV risk," the news agency writes. CDC officials said though the evidence for injectable contraceptives is inconclusive, they too are safe, according to Reuters. "Women at risk for HIV infection or who already have the virus 'can continue to use all hormonal contraceptive methods without restriction,' the CDC said," the news agency writes. However, "the CDC also said it was 'strongly' encouraging the use of condoms as a precaution against the virus that causes AIDS," Reuters notes (Beasley, 6/21).

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Working Together for a Safer South Africa for Women and Children. 10/07/2012

(UNFPA) British Parliamentary Under-Secretary of State for International Development Lynne Featherstone paid a visit to South Africa this week  keen to hear more about the  Safer South Africa for Women and Children Programme - a Joint Programme of the Government of South Africa in partnership with UNFPA and UNICEF.

Meeting partners in Pretoria this week, Ms. Featherstone said, "I am impressed by your work on social change and especially on the school-based interventions and interventions targeted at men and boys".

Through the Safer South Africa for Women and Children Programme, UNFPA and UNICEF are working together with the Departments of Women, Children and People with Disabilities (DWCPD), Social Development (DSD) and Basic Education (DBE) to strengthen national state institutions in tackling violence against women and children. The programme also aims to enhance child protection mechanisms and promote social change in norms to prevent violence and abuse. The programme is supported by the British Department for International Development (DfID) who also convened the meeting.

During the meeting, UNFPA Gender Expert Sakumzi Ntayiya gave a background to the partnership.

"The key challenge that this Programme aims to address is the gap between solid policies and the reality that many women and children still face in the country today. We are therefore focussing on creating a model to sustain a preventive institutional and social environment"


Implementing partners then too the stage to give some  insight on how goals are being met in the field. First out was Gilles Virgili who outlined the work of Save the Children South Africa on enhancing children's participation for change and to ensure protective environments in schools and communities.

loveLife, an HIV prevention NGO working with young people showed how they are mainstreaming issues on gender and violence into their existing structures. With presence in 3600 schools, 560 health clinics as well as massive interaction on social media platforms and phone hotlines, loveLife has been identified as a strategic partner to engage young people in changing social norms that result in violence against women.2.	Nomxolisi Malope and Clinton George from loveLife

The organization's Senior Manager for Strategic Projects Nomxolisi Malope gave examples of some of the activities: "Recently 30 young peer-educators that we call groundBreakers were  trained to produce citizen journalism on gender based violence in their communities. We are also conducting community dialogues and facilitating discussions with parents on GBV. Our strategy is to work with young people and through their own channels."

Bafana Khumalo, a Senior Programme Specialist from Sonke Gender Justice Network spoke next about their activities on changing masculinity norms and working with men and boys to prevent violence. "Gender injustices are not a women's issue but this is not a men's programme. It's a human rights programme. Partnering with the women's movement, government departments as well as community leaders we are working to address issues of violence"

Concluding the meeting the Under Secretary underlined the importance of preventing GBV in developments terms, stating that rendering half the population unable to deliver is a disaster.

She stressed the importance of following up results to make sure that there are demonstrable and lasting changes in behaviour and reducing levels of violence.


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Beyond "Getting Over It": Why Trauma and Gender Violence Matter in HIV/AIDS. 4/6/12

Trauma -- experiences of physical or sexual violence, among other forms of psychological disruption -- is a key driver of the HIV epidemic among women in the U.S.

The Body

By Olivia Ford
4 June 2012

Back in March, President Barack Obama announced a working group to address how gender-based violence affects women's vulnerability to HIV/AIDS. Obama's memorandum on the inter-agency team doesn't specifically address trauma, but trauma and how people cope (or are unable to cope) with traumatic experiences are a key part of what he's talking about.

First, let's unpack what "trauma" is. In simple terms, when a person experiences a traumatic event, he or she sometimes cannot heal from or move past the experience, whether consciously or subconsciously. According to the Justice Resource Institute's renowned Trauma Center, common responses to trauma include a tendency to isolate oneself and feel detached from others, emotional numbing, difficulty trusting, difficulty concentrating or remembering, and feelings of shame or self-blame. It's easy to see how any one of these conditions could interfere with a person's ability to negotiate safer sex, use condoms, or access and stay in care if he or she becomes HIV positive.

This is why simply telling a person to "get over it" won't help him or her move past trauma -- the individual needs acknowledgement and support to help change those mental patterns.

Fittingly, findings from two studies dealing with trauma and the HIV epidemic came on the heels of Obama's announcement. Researchers from the University of California, San Francisco (UCSF) and Harvard Medical School found that trauma -- experiences of physical or sexual violence, among other forms of psychological disruption -- is a key driver of the HIV epidemic among women in the U.S.

In the first-ever study to show a significant link between recent trauma and HIV-related health struggles, Edward Machtinger, M.D., director of the Women's HIV Program at UCSF and the lead researcher on both these studies, spoke with 113 non-transgender and trans-identified women in his clinic. He found that those who'd experienced trauma recently had a startlingly higher likelihood of having their HIV med regimens fail than those who hadn't. These women were also more than three times as likely to have had unprotected sex with partners who were HIV negative or whose HIV status was unknown.

In the second report, Machtinger reviewed 29 past studies and found that women living with HIV were two to six times more likely to have experienced traumatic events and post-traumatic stress disorder (PTSD) than women in the general population. One of the most troubling findings was that 60 percent of HIV-positive women reported having been sexually abused at some point in their lifetime -- more than five times the percentage among women in the general population who reported sexual abuse.

Machtinger believes these studies prove that providers need to know more about trauma, in order to better support their patients' drug adherence and overall health. "We have to learn to ask about trauma," he says; "This is actually an amazing opportunity to have a significant impact on the HIV/AIDS epidemic, especially among minority women."

Again, let's be clear: According to these studies, it's not just a handful of women living with HIV who have experienced or been affected by some form of violence. This is most women living with HIV. HIV services that don't take into account the impact of trauma on women's lives are selling most HIV-positive women short on their care.

While the connection between gender-based violence and poor HIV health outcomes may have just made the news, it is by no means new. HIV-positive women and their advocates and providers have witnessed and spoken out about this link for years.

In late February, the Presidential Advisory Council on HIV/AIDS (PACHA) held the first meeting in its 17-year history that focused on women and girls. In the course of each presentation at that meeting, all of the presenters -- each a longtime veteran of women's HIV care, prevention and/or advocacy -- stressed the impact of experiences of violence on women living with or vulnerable to HIV, from childhood sexual abuse to the partner violence that may help keep condoms out of an intimate relationship.

Dr. Laurie Dill, medical director of Medical AIDS Outreach of Alabama, stated that she was unable to conduct a study of experiences of violence among women living with HIV. The reason? They couldn't find enough female clients who hadn't experienced violence to build a control group for the study.

In her presentation, noted sex therapist Dr. Gail Wyatt pointed out that HIV prevention messages generally assume that sex is consensual, and that the effects of violence have little to do with HIV transmission. It's apparent that these messages need to be adapted to assume the opposite.

Unaddressed trauma is clearly a pervasive, if silent, public health concern -- too many women, and men, have to maneuver through a life freighted with the long-term effects of violence and abuse without assistance.

So, knowing all of this, the question then becomes what is going to be done to address this issue?

Recent developments are cause for cautious optimism. The president's working group puts a policy agenda to the call to integrate HIV services with violence prevention and trauma services -- vital concerns that have been voiced by female community leaders for decades. And just weeks ago, PACHA passed a resolution that brings these women-centered goals a huge step closer to being implemented.

However, we won't soon forget that the PACHA meeting that birthed the president's working group, and this recent resolution, was PACHA's first to focus on gender -- though not because female HIV advocates have been asleep at the wheel. Behind every meeting and resolution addressing the needs of women are years of tooth-and-nail struggle to make it happen.

The social environment in which female community leaders speak to the needs of women in the HIV epidemic -- and are consistently ignored -- is the same environment in which women suffer trauma in silence. Part of breaking the cycle of gender violence, trauma and HIV will need to include demanding, growing and supporting leadership by women at every table where decisions that affect our community are made.

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ART Fights Cervical Cancer in HIV+. 14/5/12

Antiretroviral therapy reduces the incidence of pre-cancerous cervical lesions in HIV-positive women. Study also showed that HIV therapy was associated with a regression of pre-existing lesions.

14 May 2012

Antiretroviral therapy reduces the incidence of pre-cancerous cervical lesions in HIV-positive women, South African investigators reported in the online edition of AIDS. Their study also showed that HIV therapy was associated with a regression of pre-existing lesions.

“Our results indicate that compared to non-HAART [highly active antiretroviral therapy]-users, HIV-infected women on HAART are more than twice as likely to exhibit regression of cervical lesions,” the authors wrote. “HAART users with baseline normal cervical smears are significantly less likely to suffer from incident abnormalities in subsequent cervical smears.”

AIDS-defining illness

Cervical cancer has been classified as an AIDS-defining illness since 1993. Most diagnoses involve HIV-positive women in resource-limited settings, especially sub-Saharan Africa.

The malignancy is caused by high-risk strains of human papilloma virus. This sexually transmitted infection can cause pre-cancerous cell changes in the cervix and other anogenital sites.

Incidence of the other AIDS-defining cancers – non-Hodgkin’s lymphoma and Kaposi’s sarcoma – has fallen significantly since the introduction of effective antiretroviral therapy. This treatment has also been associated with the regression of disease associated with these cancers.

Determining the benefits

However, the benefits of HIV therapy regarding prevention of cervical cancer are less clear. To establish a better understanding of its potential benefits, an international team of investigators designed a study involving 1 123 HIV-positive women in Soweto, South Africa, who had at least two cervical smears between 2003 and 2009.

Their research had two aims: to compare the incidence of abnormal cervical smears in women with normal results at baseline according to the use or non-use of HIV therapy; and to assess the association between HIV treatment and the regression/progression of cervical lesions.

The patients had a mean baseline age of 33 years. Their mean body mass index (BMI) was 26.8. Smoking – a risk factor for cervical cancer – was reported by 15% of women. Symptoms of a sexually transmitted infection were detected in 18% of women when they entered the study, at which time 75% of participants had a current sexual partner.

Only 2% of individuals were taking HIV therapy at baseline, a further 17% starting treatment during follow-up.

The number of cervical smears per patient ranged from two to seven with an average of three. The median interval between consecutive smears varied from 181 to 2343 days, the median interval being 421 days.

Positive results

Taking antiretroviral therapy reduced the risk of incident cervical lesions.

Women who had a normal cervical smear at baseline were 38% less likely to develop an abnormality if they were taking HIV therapy (p = 0.001).

A low CD4 cell count was associated with an increased risk of developing abnormal cells. This was irrespective of treatment with antiretroviral drugs. Incident lesions were twice as likely to be detected in women with a CD4 cell count below 200cells/mm3 compared to women with a CD4 cell count above 500 cells/mm3(p = 0.001). Smoking was also associated with an increased risk of new cervical disease (p = 0.05).

There was some evidence that antiretroviral treatment was associated with a reduced risk of the progression of cervical lesions. After taking into account other possible risk factors, the investigators found that HIV therapy reduced the risk of progression by 20%. However, this fell short of significance (95% CI, 0.56-1.13;p =0.20).

In contrast, HIV treatment was associated with the regression of lesions. The odds of regression were over twice as high for individuals taking antiretroviral therapy (OR =2.61; 95% CI, 1.75-3.89; p < 0.001).

“We found that women on HAART were more than twice as likely than non-HAART users to demonstrate regression in consecutive smears,” conclude the authors. “In addition, we found that among those women with a baseline normal smear, those on HAART were significantly less likely to develop an abnormality in the future.”

Source: Health Systems Trust

Reference:  Adler DH et al. Increased regression and decreased incidenceof HPV-related cervical lesions among HIV-infected women on HAART. AIDS 26,online edition. DOI: 10. 1097/QAD.0b013e32835536a3, 2012.

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Protecting Young Women. Living with AIDS # 515. 10/05/12

Reducing the number of new HIV infections amongst young girls and womenn is one of the key focus areas of the new South African National Strategic Plan on HIV and AIDS, which came into effect last month.

10 May 2012

New and bold efforts are needed to reduce the number of new HIV infections amongst young girls and women. This is one of the key focus areas of the new National Strategic Plan on HIV and AIDS, which came into effect last month.

Young South Africans between the ages of 15 – 24 are at great risk of HIV infection. But girls and young women in this age group are more susceptible to HIV infection than men in the same age group.      

“The situation in the country is that about 5 million people are living with HIV. We have a high population of young people in our country. About 42 % of our young people are under the age of 20. And young women are vulnerable to HIV infection than their counterparts, which are young men, mainly for physiological reasons”, says Rhulani Lehloka, Executive Director of the AIDS Consortium.     

As a result, policy makers believe that there is a dire need for the youth, especially girls, to be exposed to sex education to help protect them from HIV infection and other attendant pitfalls of sex.

“There just has to be good, clear educational programmes that talk to young girls about their sexuality and about sex and about the risks that are associated with sex. It’s not just the risks of HIV infection, which is, of course, a major risk, but the risks of sexually transmitted infections and the risks of pregnancy. We want every single girl in this country to understand her body and to understand her body in relation to the development of her sexuality”, says Mark Heywood, deputy chairperson of the South African National AIDS Council (SANAC), the custodian of the National Strategic Plan (NSP) on HIV and AIDS, TB and STIs.  

Heywood says a number of social factors often ensure that girls and young women are not equal partners in their sexual relationships.

“We have to empower young girls in the environments that they go to school in and that they live in. We know that because of poverty, because of inequality many young girls have sexual relationships with older boys or with men and that they feel disempowered in those relationships. We have to give them power, we have to give them the understanding that if they are going to have sex that they must insist on condom use by their male partners. And if their male partner refuses to use a condom, then, we say that young girls and young women should refuse to have sex in those circumstances”, he says.

But, he cautions that parents need to come on board to assist programmes that seek to protect girls from the harm that may arise as a consequence of sexual activity.

“Preparing girls for sexuality is a responsibility that every parent has. Preparing girls for both the joys and risks of a developing sexuality is something that parents have to help with. So, we’ve got to get that discussion going and if we can be successful in that, then, we think that we can begin to cut the rates of HIV infection amongst this important group”.

Policy-makers argue that sex education and reproductive health services need to be offered as part of the school system. Until now, the Department of Basic Education has outlawed the provision of condoms in schools. This is largely because parents and school governing bodies have opposed condom provision as they believe that they will promote sexual activity.

But the Health Department says this belief fails to recognise the reality that children have sex at an early age.   

“We are still in discussion with the Department of Basic Education… whether we can talk about sexual and reproductive health in schools. And if we do, can we render services? Can we give children contraception at schools or do we have to wait for them to come to facilities when they are already pregnant? We can bury our heads in sand and say: ‘These kids are nice kids. They don’t engage. They just wake up, go to school and come back’. That is actually burying our heads in sand. So, the question is: If parents are not really comfortable with these services in schools, how do we go about addressing this problem? I think this is what we have to deal with”, says national Health Department Director-General, Precious Matsoso. 

The South African National AIDS Council says although higher rates of HIV infection are evident amongst young girls, HIV prevention efforts should not be limited only to this group of young people. SANAC deputy chairperson, Mark Heywood, says in order to maximise the impact of such programmes, they also need to involve boys. 

“These programmes have to talk to young boys as well and we have to bear in mind that if you don’t do that, then, young boys grow up, they leave school and they become people who have not been equipped to judge their own behaviours towards people that they may have relationships with at some point in future”, he says.    

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Men Taking the Lead in Eliminating New HIV Infections among Children and Keeping Mothers Alive. 21/3/12

Zimbabwean organisation's (Padare) goal is to subvert this exclusive male practice and bring together traditional and local leaders, pastors, grandfathers, fathers, uncles and brothers to discuss cultural and social issues related to gender justice and equality

21 March 2012

Sitting on a traditional stool at a Dare—a special meeting platform, Chief Chiveso of Mashonaland Central Province in Zimbabwe speaks to men about the possibility of having babies born HIV free and keeping their mothers alive. For that to happen, stresses the Chief, there is a need to challenge harmful cultural and religious practices that can affect community responses to HIV.  "As a Chief, I am going to continue supporting and leading health issues in my village so that families can live better.”

Chief Chiveso has the support of Padare/Men’s Forum on Gender—a Zimbabwean organisation that works with traditional leaders in Mashonaland to influence public opinion on various community issues. These include the promotion of HIV services and mobilising men to actively participate in preventing new HIV infections among children.

Men play a significant role in defining community practices. Traditionally, Zimbabwean men would gather around a fire or under a tree to discuss community issues and make decisions about the community while excluding women and children. This practice fuelled gender inequalities since most decisions did not take into account women’s views.

Padare’s goal is to subvert this exclusive male practice and bring together traditional and local leaders, pastors, grandfathers, fathers, uncles and brothers to discuss cultural and social issues related to gender justice and equality, including the support for programmes to stop new HIV infections among children.

"In these communities men have positions, power and privileges that come from patriarchal values. We are harnessing their power so that they can be agents of social change in their communities," said Kevin Hazangwi, Director of Padare.

Zimbabwe’s National AIDS Strategic Plan aims to reduce transmission of HIV from mothers to children from 14% in 2010 to 7% in 2013 and to less than 5% by 2015. Currently, Government figures indicate 70% coverage of prevention of mother-to-child HIV transmission services in the country.

Rising community voices in HIV action

Through the Padare initiative, Chief Chiveso engages men in open dialogues where community members are encouraged to challenge low health seeking behaviours in the village and to understand HIV prevention, treatment and care services. These interactive dialogues—known as Community Conversations—enable community decision-making and actions concerning the elimination of HIV.

“This programme gave me a lot of knowledge about existing antiretroviral drugs and HIV prevention services,” said Tatenda, a proud father living with HIV. “I was supporting my wife when she was in labour. I now have twins who were born HIV negative.”

We are harnessing the power of men so that they can be agents of social change in their communities

Kevin Hazangwi, Director of Padare

Padare also conducts consultative meetings that tap into the local rich traditions. These meetings enable communities to identify gaps in knowledge and attitudes, behaviours and cultural practices that are harmful to the AIDS response.In these open discussions, community members are able to raise key issues and provide solutions without personalising the issues. Spousal inheritance and girl pledging for spirit appeasement—offering of a young girl to remedy criminal offences or to appease the spirit of a murdered person—are among the negative cultural practices that are discussed.

A higher-level platform known as Indaba is also used by Padare to engage the Chiefs themselves to advocate for greater action in their respective communities. Such dialogue enables the Chiefs to agree on sound HIV policies ensuring the involvement of men in preventing new HIV infections at community and national level.

“As Chiefs we should play a major role in sensitising our communities. Over and above the right of children to a dignified life, the babies we are losing are potential nurses, doctors and teachers for our society’s tomorrow,” added Chief Chiveso.

Traditional leaders as custodians of culture

Faith-based leaders in Mashonaland Central are also taking action to change negative religious and cultural practices and boost service uptake in their communities.

“Religion and the church have been accused for being the source of male chauvinism and patriarchy. We pledge to keep it as a fountain of hope, a source of information and health,” said Pastor Sifelani, of the Anglican Church in Bindura. “Gone are the days when we would encourage people to flush away antiretroviral drugs because they have been healed and we blamed witchcraft for sickness and death instead of HIV.”

Traditional leaders are considered the custodians of culture and are therefore critical to shift society’s attitudes. Bringing together communities to discuss issues in their own terms has a positive effect in increasing HIV service uptake. There is greater scope for replicating this programming model in sub-Saharan Africa where the idea of men’s forums is culturally appropriate and can be traced to past and current practices.

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WHO Clarifies Guidance on Hormonal Contraception and HIV. 17/2/12

WHO has reaffirmed the birth control method's safety, but strongly recommends that women on progesterone-only injections, like Depo-Provera, also use condoms to prevent HIV infection.

17 February 2012

Johannesburg - Four months after a study suggested women on hormonal contraception may be at an increased HIV risk, the World Health Organization (WHO) has reaffirmed the birth control method's safety, but strongly recommends that women on progesterone-only injections, like Depo-Provera, also use condoms to prevent HIV infection.

In October 2011 the British medical journal, The Lancet, published the findings of a study showing that women who relied on hormonal shots to prevent pregnancy doubled their HIV risk. They also found that women on this type of birth control and living with HIV doubled the chances that they could transmit HIV to their partners.

Although the women in the study did not identify their birth control methods, most were probably using the progesterone-only, depot medroxprogeterone acetate shot. More commonly known by the brand name, Depo-Provera, this drug is the backbone of most African family-planning programmes.

The study prompted WHO meetings in late January and February 2012, during which experts and civil society representatives reviewed research on hormonal contraception and HIV risk. However, because no clinical trial has ever looked specifically at this potential link, including the October 2011 study, evidence remains largely inconclusive.

In the absence of a proven link between hormonal contraception and HIV infection, the WHO issued a statement on 16 February standing by current guidelines that allow women living with or at high risk of HIV to use hormonal contraception. However, the body has recommended that current guidelines be amended to advise women using progesterone-only injections be strongly advised to use condoms concurrently to prevent HIV infection. 

The need for future research into the matter was discussed at side meetings, said Dr Jared Baeten of the US University of Washington, one of the authors of the 2011 study. Although no decision was taken, he added that conducting such a trial would pose serious challenges. About 12 million women in sub-Saharan Africa are estimated to be on injectable contraception.

Women need options and integration

"I think the [WHO] statement really reflects what was an extremely thoughtful deliberation and detailed evaluation of the evidence," Baeten told IRIN/PlusNews.

"They made a clear statement by issuing a strong clarification and I think that what's important in the context of delivering family planning service is that we strongly remind women at high risk of HIV that contraception does protect against HIV and that condoms are the HIV preventative measure."

Baeten has worked in high HIV prevalence countries such as South Africa, Kenya and Uganda - all of which depend on family planning services to help fight high maternal mortality rates - and said he was also happy that the need to integrate family planning and HIV services, voiced by policy-makers and researchers at the meeting, was recognized.

This would mean that health facilities providing care and treatment for HIV and other sexually transmitted infections would offer clients family planning and reproductive health services - and an extended array of contraceptive choices.

"What this statement should stimulate is making sure that women have access to a variety of contraceptive choices, and this could include intrauterine contraceptive devices (IUCD) or lower-dose, long-acting hormonal contraception," Baeten added. "The point is that Depro shouldn't be the default."

IUCDs are available in both hormonal and non-hormonal forms. A device is inserted into a woman's uterus, where it affects the ability of the sperm to fertilize an egg, and the egg's ability to implant itself in the uterus. The devices are cost-effective and work for almost all women, according to research by the Maternal, Adolescent and Child Health division at the University of the Witwatersrand in South Africa.

Dissent in the ranks

There has been some criticism of the WHO. Paula Donovan, former East and southern Africa AIDS advisor for the UN Children’s Fund (UNICEF), now heads the international HIV advocacy organization, AIDS-Free World, with former UN Special Envoy on AIDS in Africa, Stephen Lewis.

Days before the WHO released its statement, Donovan issued a statement of her own slamming the body for not moving sooner on consultations when it had convened emergency meetings on past issues like swine flu.  She faulted the WHO for not involving more people living with HIV in discussions, and because the body did not issue clear or cautionary messaging to the public following the 2011 study.

According to Donovan, only one HIV-positive African woman was present at the WHO meeting, and confidentiality agreements prevented her from sharing what was discussed with networks of activists and people living with HIV.

Donovan has also criticised the WHO statement, saying that it goes too far by conclusively stating that women living with or at high risk of HIV can continue to use hormonal contraception when the evidence is inconclusive.

"WHO and UNAIDS have violated human rights by withholding information," Donovan said in her statement. "They have failed to inform women that using hormonal contraception may carry some risk. Women have the right to make fully informed sexual and reproductive health decisions."

She added that she would have liked to see the WHO go further in its recommendations, advising that all hormonal contraceptive users be given a three-month supply of condoms with every injection.

"No reasonable person can believe that condom use will increase because the WHO issued a statement declaring that hormonal contraceptives are safe - but condoms should also be used to protect against HIV," she told IRIN/PlusNews. "Statements don't prevent HIV. We would have hoped that [the] announcement would have been accompanied by a plan of action."

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Gender News 2011

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Sexual Violence among Men Neglected. 18/10/11

Almost 10 percent of South African men have experienced sexual violence by another man, according to new research that probes the complex relationships between male victimisation and HIV risk.

18 October 2011

Cape Town - Almost 10 percent of South African men have experienced sexual violence by another man, according to new research that probes the complex relationships between male victimisation and HIV risk.

The findings presented at the annual Sexual Violence Research Initiative in Cape Town by Kristin Dunkle, assistant professor at the Rollins School of Public Health at Emory University in the US, are based on a household survey conducted among about 1,740 men in two of  South Africa's nine provinces - KwaZulu-Natal and the Eastern Cape - by the Medical Research Council (MRC).

Published in 2009, the research became commonly known as the "MRC rape study" and showed that more than one in three South African men admitted to having raped a woman - but little attention was paid to sexual violence experienced by men.

Many male survivors had reportedly been forced to engage in typically low HIV risk acts such as thigh sex, in which a man placed his penis in between their thighs, or masturbation. However, about 30 percent reported being anally or orally raped.

Men who have sex with men (MSM), or men who choose to have sex with men but do not necessarily identify themselves as gay, were more than nine times as likely to report having been raped than other men. About 3 percent of men reported sexually assaulting another man, about half of those who reported having raped a man.

Mirroring previous South African studies that showed an elevated HIV risk among men who commit intimate partner violence and the women they assault, Dunkle's work found that the perpetrators as well as the survivors of male-on-male sexual violence were generally more likely to be HIV positive.

There was one exception: rape survivors who did not identify as MSM. HIV prevalence among this group was not significantly different from men who have never been sexually assualed.

Love hurts

While the apparent lack of HIV-risk among male rape-survivors who are not MSM may seem puzzling, Mary Ellsberg, vice president of research and programmes at the International Centre for Research on Women, said the difference is almost certainly indicative of partner violence among MSM in relationships, and likened it to the rising HIV risk that accompanies women in abusive, long-term relationships.

"From previous MRC studies we see that [high HIV prevalence] results  from a combination of factors for women who are beaten and raped by their husbands - they are having consistent sexual encounters with these men," Ellsberg told IRIN/PlusNews.

"But we also know that women who are raped only once by a stranger – while they can contract HIV from the rape – don’t have a higher HIV prevalence than other women overall. The rape of men who aren’t MSM also seems unlikely to be ongoing, so it’s an infrequent exposure and it makes sense that their risk is similar to the general population."

The situation is different men in relationships with other men, who could be in long-term relationships with high risk, abusive men with whom they would have sex with, either consensually or not, over time.

A quarter of MSM who had been raped were HIV-positive. Intimate partner violence between men could also explain why four times as many MSM reported having committed sexual violence against another man.

It's not just about the men

With two-thirds of MSM reporting that they were currently involved with a female partner, the findings have implications for men and women alike.

The overwhelming majority of perpetrators also reported being violent towards their female partners, an HIV risk factor for women in South Africa.

"Overwhelmingly, the men who are perpetrating violence against men are also perpetrating violence against women - there's more than a 80 percent overlap when you look at physical abuse of female partners.

We need to really think about the implication of this in terms of the risk for women, and interrupting the cycles of sex, violence, and HIV transmission," Dunkle told IRIN/PlusNews.

"When we're talking about violence linked to masculinity, we need to be thinking about it more broadly and be sure that we also look at men’s violence towards other men. "

About half of the male sexual violence survivors said they had raped a woman, and 25 percent had done so in the last year.

While Dunkle cautioned that more data on male-on-male sexual violence and rates of female-male partner concurrency were needed before policies and guidelines could be changed, she urged health service providers never to assume a man's sexual history or rule out the possibility of male sexual assault.

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Rethinking Contraception and Infection Risk. 7/10/11

Hormonal birth-control injections may double a woman's risk of contracting HIV and passing it on to her partner

7 October 2011

Johannesburg - Hormonal birth-control injections may double a woman's risk of contracting HIV and passing it on to her partner, according to a new study. The research comes at a time when many governments are looking to scale up their family-planning programmes in a bid to reduce maternal mortality.

Published in the 4 October 2011 online edition of The Lancet's Infectious Diseases journal, the study followed about 3,800 heterosexual couples in seven African countries over about two years. Researchers found that women who relied on hormonal shots to prevent pregnancy doubled their HIV risk. In women who were HIV-positive, using "the shot" doubled the chances that they transmitted HIV to their partners.

Researchers also evaluated the HIV risk associated with birth-control pills. While findings suggest a similar relationship between the pill and HIV risk, study author Jared Baeten of the US University of Washington cautioned that too few women reported using the pill to draw a definite conclusion.

Although participants were not asked to identify which injectable birth control they were receiving, it is likely many were on depot medroxprogeterone acetate (DMPA), according to Baeten. More commonly known by its brand name, Depo-Provera, this drug features in most family-planning programmes in Africa

Research from South Africa, with an HIV prevalence rate of about 18 percent, has indicated it may also be the most prevalent birth control method aside from condoms.

“Active promotion of DMPA in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic," said Charles Morrison, senior director for clinical sciences at Family Health International, in a related commentary published in The Lancet.

"Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birth-weight babies and orphans - an equally tragic result."

The research could mean changes for high prevalence countries like South Africa that are hoping to lower maternal mortality by preventing unplanned pregnancies.


The study is the first to show a relationship between birth control injections and increased HIV risk, Baeten noted. While it did not investigate how, biologically, hormonal contraception increased HIV risk, participants' cervical swabs showed that HIV-positive women on hormonal contraception had increased HIV levels in their genital tracts, which may explain why their male partners were more likely to contract the virus.

"Truthfully, we don't know perfectly how HIV establishes itself... what happens between exposure and infection," Baeten told IRIN/PlusNews.

"Previous studies have suggested that perhaps contraception can lead to microscopic thinning of the vaginal mucous membrane [and] changes to genital tract... that makes it easier for HIV to establish itself."

Mucous membranes line body parts like the nose, mouth, vagina and anus. HIV can pass through this type of tissue and into the bloodstream, leading to infection. Damage to this membrane is thought to increase this risk.

Next step

Morrison urged donors to support a randomized trial to investigate the link between hormonal contraception and HIV.

"The time to provide a more definitive answer to this critical public health question is now; the donor community should support a randomized trial of hormonal contraception and HIV acquisition,” he wrote.

UNAIDS has already called for more research and analysis before a January 2012 meeting when the World Health Organization (WHO) will review various studies as it prepares to revise recommendations on HIV and contraception use.

"If a new study is proposed, it will be years until we have the results so that's why it's important to have correct messaging," said Baeten, adding that women should continue to be offered hormonal contraception but that they should be counselled about the possible risks. The importance of condom use alongside other birth control should be re-enforced.

"This study should not result in women stopping contraception - it's too important from the individual and pubic health perspective," he told IRIN/PlusNews. "It should promote a conversation about how we keep women safe while reducing unplanned pregnancy and the complications from that."

Adapting family planning in Africa

With the WHO recommending family-planning services as the first step to reducing maternal mortality and deaths linked to botched abortion, several countries, including Nigeria, Uganda and South Africa, have recently rejuvenated such services to bring down their stubbornly high maternal mortality rates.

In Uganda, USAID recently announced the rollout of the birth control pill Mycrogynon following a similar 2010 campaign in Ethiopia.

South Africa is revising its family-planning guidelines and has embarked on a national campaign to increase access to contraception.

According to Eddie Mhlanga, cluster manager for maternal, child and woman health and nutrition in South Africa's Department of Health, the new family-planning guidelines will caution health workers about the increased risk of HIV associated with hormonal contraception.

The guidelines may also demonstrate a shift towards contraception with lower hormone levels, and the re-introduction of intrauterine contraceptive devices (IUCDs), Mhlanga told IRIN/PlusNews.

The last available data from 2003 showed South Africa's hardest-hit province, KwaZulu-Natal, had the highest uptake of contraception in the country, predominately hormone injections.

To address the over-reliance on injections, the province plans to expand access to birth-control pills, including emergency contraception, as well as condoms and IUCDs, which are inserted into the uterus in order to prevent pregnancy.

According to Baeten, non-hormonal IUCDs may be a good option for women in high HIV prevalence settings.

"From the point of a medical intervention, it would be about provider preferences and patient demand," he told IRIN/PlusNews. "Whether it’s a choice in contraception or a choice of soda, part of that is about what strategies are put in place to promote it."

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‘It is the Right Time’ to Deal with Gender-based Violence. Living with AIDS # 488. 15/9/11

South Africa: Violent crime still remains endemic, with women and girls especially at risk.


Khopotso Bodibe
15 September 2011

In 1996, when South Africa returned to the World Health Organisation (WHO), the country made a resolution that declared violence a public health priority. But violent crime still remains endemic, with women and girls especially at risk.

Research shows that injury or death caused by violent crime in South Africa remains particularly high, although the scourge has gone down significantly in the last decade. Ten years ago about 60 – 70 people in South Africa would fall victim to injury or death as a result of violent crime. The rate has dropped, but is still exceptionally high compared to countries like the UK where one person out of every 100 000 would die violently every year.   

“We have got about 34/100 000. That’s indeed quite a high number compared to something under 10 for other developed countries. We are leaders in the incidence of murder, rape, robbery and violent theft”, says Dr Norman Mabasa, chairperson of the South African Medical Association (SAMA).

Mabasa adds that research also shows that South Africa has the highest rate of violence against women and girls.

“In 1997, the South African government reported rape and sexual abuse to be increasingly rapid and a matter of grave concern. In 1996 – 1998, girls aged 17 and under constituted approximately 40% of reported rape”, he says.

Violent crime in the country is at epidemic proportions and has far-reaching implications.  

“This is an epidemic that has huge consequences, not only on people’s personal lives, but also on the economy of the country and, also, the ability of South Africa to sell itself to its own people”, says Dr Gustav Wolvaardt, Chief Executive Officer of the Foundation for Professional Development (FPD), a SAMA project.

Violent crime against women, specifically rape, is a universal problem. In South Africa, it contributes to the high HIV infection levels among women.

“It exists in all countries, all religions and social classes. It also poses serious threats to public health and, in particular, sexual and reproductive health. It’s also a critical impediment to fighting HIV and AIDS. In South Africa, there are these twin epidemics of HIV and AIDS and gender-based violence. Both epidemics are severe and serious and disproportionately affect women and children. According to the latest national ante-natal survey, 30% of women between 20 and 24, 40% of those between 25 and 29 and 36% of those between 30 and 34, are HIV-positive”, Peter Teljer, Sweden’s ambassador to South Africa, explains.    

In their efforts to address sexual and gender-based violence, the Swedes have a telephone help-line.

For a relatively small country of under 10 million people, the contact centre receives about 40 000 calls per annum. Sexual violence is so rife that the World Health Organisation estimates that one-third of all women and girls worldwide will be raped and suffer sexual violence, at least, once in their lifetime.

The FPD’s Dr Gustav Wolvaardt says this is an epidemic that has been neglected. He says part of the reason the crime is so well-established is that professionals such as health care workers, including teachers, have never wanted to be involved in efforts to address sexual and gender-based violence.  He says there needs to be educational programmes to sensitise professionals such as health care workers and teachers about sexual and gender-based violence.

“Professionals, whether they are health care professionals or whether they are educational professionals, are perfectly positioned to identify victims of violence. For example, chronic victims of violence will show up within a hospital setting every six months – most of them. We’ve always left it to the psychologists or the social workers. We don’t expect them to get involved and do the work that’s expertise. But they need to know and spot patients that can be referred or spot kids because children are a very sensitive barometer of what happens in a household. These training programmes will ensure that these professionals can identify and then refer people for care”, Wolvaardt says.       

He says it is with a great sense of guilt that he recognises that even though South Africa flagged violence as a global public health threat more than a decade ago, his profession has for a long time overlooked sexual and gender-based violence.    

“I was part of the South African delegation that wrote that resolution in 1996 that we took to the World Health Organisation to say violence is something the health sector should get involved in. But, somehow, in South Africa we didn’t translate that focus that we created internationally into actions at a local level”.

“Part of it is because, firstly, it is a difficult problem and, secondly, it’s not a problem that people really want to grasp with.  So, it’s taken really a long time. And my experience was very similar to what my experience was in the beginning of the AIDS epidemic. When you went to people and said: ‘We want to do something about AIDS’, they used to say, ‘oooh, no, no, no. We don’t want to link our logo to that’. But it is changing. I think everything is aligning… coming right. It is the right time to do this. I feel a bit guilty. I think this is a big issue that we’ve not given sufficient attention in the country”, says Wolvaardt.

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Women's Latest Bargaining Tool. 24/8/11

Marriage increases the frequency of sex and impedes a woman's ability to negotiate condom use or abstain from sex.


Johnson Siamachira
24 August 2011

"WOMEN think that when you're married, you don't have to worry about HIV. They think it is a safe haven,"said Beauty Nyamwanza of the National Aids Council.

But marriage can actually fuel the risk of HIV among women, particularly the young.

Research has shown that marriage increases the frequency of sex and impedes a woman's ability to negotiate condom use or abstain from sex.

In essence, married women find it difficult to request their husbands to use condoms, even to use one themselves as this would be seen as if they are promiscuous.

When Aids first struck in the 1980s, it mainly affected men. Now, globally about half of the 33,3 million people infected with HIV today are women, and in sub-Saharan Africa, the share rises to 60 percent.

The large majority are infected through unprotected sex with their husbands or long-term primary partners.

Nyamwanza recently told a media seminar in Kadoma: "Marriage, once thought to protect women from sexually transmitted infections, puts many girls and women, especially those who marry much older and more sexually experienced men, at risk."

But with interventions of Nyamwanza and others, Zimbabwe is one of the countries that has made impact with the female condom and has made great strides in promoting its use.

The latest device, the FC2 is a strong flexible nitrile sheath, about 17 centimetres long, with a flexible ring at each end.

The closed end is inserted into a woman's body, and the open end remains outside during intercourse.

Like the male condom, it offers dual protection against unintended pregnancy and sexually transmitted infections, including HIV.

Also, it has a key advantage, it is the only available technology for HIV prevention that women can initiate and control.

Zimbabwe is cited as a success story in female condom use and has the highest distribution and sales of the condom in the world, according to the United Nations Population Fund.

"This is as a result of strong civil society participation, innovative social marketing, comprehensive condom distribution mechanisms, capacity building of service providers in the public, private and social marketing sectors as well as sustained political will, financial and technical support from the Government and funding partners respectively," says Sinokuthemba Xaba, the National Condom

Programme Co-ordinator in the Ministry of Health and Child Welfare.

He also says, "Our case provides important insights for female condom introduction, effective distribution and programming and high rates of acceptability."

Considering that choices to prevent HIV are limited, the female condom is the only available method which offers some degree of control to women who wish to protect themselves and their partners from the risk of sexually transmitted infections(STIs)/HIV and unwanted pregnancy.

The female condom is a tool that women can use to negotiate for safer sex as well as to facilitate communication with their partners about other reproductive health issues.

"The female condom is a tool that women can use to negotiate for safer sex as well as to facilitate communication with their partners about other reproductive health issues," Xaba says.

Women's rights and reproductive health organisations played a vital role in bringing female condoms to the country through identifying a need for the product and advocating Government's support in procurement.

First, an acceptability study on a small sample of family palling participants in rural areas and sex workers was conducted in 1995.

The results of this study found female condom acceptability to be over 50 percent among all categories of women, according to the Ministry of Health and Child Welfare.

Consequently, the Women and Aids Support Network mobilised 30 000 people, most of whom were women, to petition Government to introduce the female condom.

The Ministry of Health and Child Welfare responded and the female condom was brought into the country.

"Women and Aids Support Network (WASN) organised a successful, nationwide petition drive in support of female condoms that coincided with the government's efforts," says Mary Sandasi, WASN Executive Director.

In 1997 the female condom was made widely available through public sector outlets.

Soon after this launch, the female condom public sector programme conducted a pilot study in 30 districts (six of which were urban and 24 of which were rural). This study lasted for approximately one year and its results indicated 74 percent and 91 percent acceptability levels in men and women respectively.

At first, acceptance of the female condom was low due to policy and programmatic constraints; especially limited stock availability made it impossible to meet the demand that had been created and a general lack of strategic direction and coordination marked the erratic nature of the public sector programme.

In 2002, new attempts were made to develop a targeted female condom strategy, but efforts again came to a standstill due to the inability to secure regular supplies.

Despite significant envisaged potential, the public sector programme failed to maintain a high degree of coverage.

On the other hand, as initial curiousity and interest drove people to try this new product, the social marketing programme experienced a sudden increase in sales soon after introduction of the female condom in 1997.

This later stabilised.

In response to this, the Government requested support from UNFPA to enhance the promotion of both the female and male condoms through the public sector.

Population Services International (PSI) adopted a targeted marketing approach to the female condom in 2001 and has since expanded the social marketing programme to married women, women living with HIV and Aids, women in discordant relationships, and young females (aged 19-25).

Annual distribution increased steadily between 2001 and 2005.

In 2005, PSI expanded its channels to include groups of sex workers, groups of People Living with HIV and Aids, Care and Support Organisations and tertiary institutions.

Currently, sales continue to thrive.

Recognising the need for a more strategic urban/rural and public/social marketing approach in Zimbabwe, UNFPA facilitated and supported Government in forming a Technical Support Group on condom programming.

The TSG, comprising of representatives from the Ministry of Health and Child Welfare, the Zimbabwe National Family Planning Council, PSI, civil society organisations and donors, assisted the government in undertaking a Female Condom Research review as well as a situation analysis to provide evidence for the development of a national female condom strategy for 2006-2010.

In addition to training condom promoters, PSI used various ways to educate the public about condom use.

Langton Ziromba is one person who was trained in the promotion of female condoms.

He lives in Budiriro where he owns a small, outdoor barbershop. Ziromba provides information about female condoms to his clients, the advantages to both partners and how they are used.

He is one of 70 barbers and 2 000 hairdressers in Zimbabwe who were trained to promote the female condom.

Ziromba sells one of the country's most popular brand, the Care condom.

One of the partners in this programme is the Zimbabwe National Family Planning Council (ZNFPC).

Margaret Butau, of the ZNFPC says her organisation's research shows that for this product to be acceptable and used by women there is a strong need to involve men.

"We customise the benefits of the female condom according to the target group," she says, adding that specific points highlighted in this education drive aimed at men include the fact that the female condom is not constricting like the male condom, does not break easily, its use does not require an erection and it enhances pleasure for both partners. Even better: it is not ideal to withdraw immediately after ejaculation. Above all, she says, it is the woman's responsibility.

"When this is discussed with the men, we find that men become curious about having their partners try the product."

Most women interviewed had a lot of praises for the female condom. But they said it was difficult to make their husbands use it at first. They laughed about its size and shape, about their partners' first reaction to it, and about the changes it had brought to their relationships.

"When I took it home for the first time, my husband quarreled with me, saying he would never eat a sweet with its wrapping on," said a 35-year old women from Dzivaresekwa. Most of the women said that using the female condom had given them courage to discuss sex with their husbands and boyfriends.

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Hormonal Contraceptive Use Increases Women’s Risk of Acquiring and Transmitting HIV. 21/7/11

Greater risk both of acquiring HIV themselves and of passing it on to a male sexual partne


By Roger Pebody
21 July 2011

A two-year, seven-country study has concluded that women using hormonal contraceptives, particularly injectable forms, are at a greater risk both of acquiring HIV themselves and of passing it on to a male sexual partner. Presenting the results to the International AIDS Society conference (IAS 2011) in Rome yesterday, Renee Heffron of the University of Washington said that strategies are needed to improve access to and uptake of lower-dose contraceptives and non-hormonal methods – such as IUDs, implants, patches or combination injectables.

The new study will be considered alongside the findings of a number of other studies that have also found an association between hormonal contraceptive use and HIV infection in women. However, this link has not been found consistently in all research. Most notably, a five-year study conducted with 6109 women in Zimbabwe, Uganda and Thailand found that neither the combined oral contraceptive pill nor DMPA (Depo-Provera) injections were associated with HIV infection.

The new findings are also notable for their investigation of the effect of contraceptive use on onward transmission to men – a previously unexplored area.

The data come from an analysis of 3790 serodiscordant couples (i.e. 7580 people) in South Africa, Botswana, Zambia, Tanzania, Uganda, Kenya and Rwanda. In two-thirds of the couples, the female partner was HIV-positive, in one-third, the man.

The couples were recruited either as part of the Partners in Prevention cohort or for the Couples Observational Study (a study of immune correlates of HIV protection). Every three months, data were recorded on contraceptive use and sexual behaviour. HIV-negative partners were tested for HIV at the same frequency; only seroconversions that were determined by gene sequencing to have been acquired from the study partner were included in the analysis.

Most couples were married and had at least one child together, on average.  At enrolment around a quarter of couples reported having unprotected sex in the last month.  A quarter of couples experienced a pregnancy during the two-year study

HIV acquisition in women

Overall, 21% of HIV-negative women used hormonal contraception at least once during the study period. Injectable contraception was used at least once by 16% of women and oral contraception was used at least once by 7% of women.

Of the 1314 HIV-negative women, 73 acquired HIV. Incidence among women using contraception was 6.61 per 100 person-years, compared to 3.78 per 100 person-years among women not using contraception.

After adjusting for confounding factors in multivariate analysis, women using any hormonal method had twice the risk of acquiring HIV as other women (hazard ratio 1.98, 95% confidence interval 1.06 – 3.68).

An analysis of women using injectable methods gave similar results. However, the findings were not statistically significant for women using oral contraceptives – this may be because fewer women in the study used oral methods, so there was not statistical power.

HIV transmission to men

Of the HIV-negative men, one-third of their female partners used hormonal contraception at least once during the study. Injectable contraception was used by 27% and oral contraception by 9%.

Of the 2476 men, 59 acquired HIV from their primary partner during the study. HIV incidence in the partners of hormonal contraceptive users was 2.61 per 100 person-years, compared to 1.51 per 100 person-years among men whose partners did not use contraception.

After statistical adjustment, men whose partners used any form of hormonal contraceptive had twice the risk of acquiring HIV as other men (hazard ratio 1.97, 95% confidence interval 1.12 – 3.45).

Again, the findings in relation to injectables were very similar, whereas those in relation to oral contraceptives were not statistically significant.

A possible mechanism for the increased transmission from women to men is that users of hormonal contraceptives had higher levels of genital HIV viral load than other women.

An examination of genital samples from 1691 women – with the figures adjusted for blood viral load and CD4 count – found that women using hormonal contraception were more likely to have detectable genital viral loads and a greater quantity – by 0.14 logs. The difference was driven by injectable users who had a 67% increased odds of having a detectable genital viral load compared to non-users.


“It’s clear that the benefits of effective hormonal contraception are unequivocal – especially when you think about maternal mortality – and the risk of HIV infection really needs to be balanced with these benefits,” researcher Renee Heffron said.

She recommended that women and couples should be counselled about both the HIV risks and the importance of dual contraception – condom use in conjunction with hormonal contraceptive use.

Ward Cates of Family Health International and Professor Helen Rees of the Wits Reproductive Health and HIV Institute both commented that the findings underline the relevance of the intrauterine device (IUD) as a contraceptive choice for women in high-prevalence settings.

Rees noted that the South African policy on contraception was in the process of being revised and would take these findings into account. "The entire policy is being written in the context of HIV, because there is no such thing as a pocket of HIV in our setting," she said.

She noted that, while current thinking was that lower-dose hormonal methods would be safer, this has not actually been empirically tested. She called for randomised controlled trials, which would not be subject to the challenges of bias and confounding factors found in all observational studies (including the one described here).

She also commented that establishing the safety of hormonal methods is particularly important in the light of moves to develop multipurpose health technologies – such as microbicides and vaginal rings – which could simultaneously prevent unwanted pregnancy, HIV infection and other sexually transmitted infections.

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Achieving Sexual and Reproductive Health and Rights for Women and Girls through the HIV Response. 19/7/11

Women and girls at the community level, and at every level, must be supported to demand quality services that meet their needs and those of their community

19 July 2011

On the periphery of the IAS 2011 conference taking place in Rome from 17-20 July 2011, UNAIDS in collaboration with the Global Coalition on Women and AIDS (GCWA), ATHENA, Salamander Trust, WECARe+ and Network Persone Seropositive convened a town hall dialogue to discuss how the HIV response facilitates the achievement of sexual and reproductive health and rights for all women, including women living with HIV, at every stage of their lives. 

For women living with HIV stigma and discrimination and gender-based violence acutely affect their access to comprehensive services and human rights. Within health services, they often face a lack of choice with regard to family planning; disapproval from service providers with regard to meeting sexuality and fertility desires; and violation of their sexual and reproductive rights in the form of coerced or forced abortion or sterilization. Participants agreed that advancing the health and rights of women in all their diversity is fundamental to the success of the HIV response, just as the HIV response is a critical avenue for achieving sexual and reproductive health and rights for women.

The event was also used as a platform to launch a report Community Innovation: Achieving sexual and reproductive health and rights for women and girls through the HIV response. Compiled by UNAIDS and the ATHENA Network, it presents case studies pioneering community undertakings to advance women’s sexual and reproductive health and rights through the HIV response and vice-versa, from different community perspectives. This report recognizes that women face unique challenges to access and fulfil their sexual and reproductive health and rights, including gender-based violence, and therefore have less access to HIV prevention, care and support services.

“Women and girls at every level and throughout different stages of their lives must be supported to demand quality services that meet their needs and those of their community,” said UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay.

Learning from these community case studies is an opportunity to enhance the AIDS response, in light of the Millennium Development Goals and the 2011 Political Declaration on HIV/AIDS. The case studies indicate that for responses to be effective they must include the empowerment and inclusion of women in all their diversity, dedicate attention to sexual and reproductive health, including improvements in maternal and child health, and address the socio-cultural practices underlying gender inequality.

UNAIDS Getting to zero: strategy 2011-2015 also places gender equality and human rights as one of three core pillars. This report is part of that commitment to ensuring that women and girls’ rights are met through the HIV response and it was undertaken in the context of the UNAIDS Agenda for accelerated country action for women, girls, gender equality and HIV. 

“UNAIDS continues to be a strong advocate for women’s health and rights, as well as to strongly stand against stigma and discrimination amongst all marginalized groups. We will continue to do so until we have achieved the vision of zero discrimination,” said Dr De Lay.

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Lesbian and Bisexual Women Vulnerable to HIV. 5/7/11

Misconception that these women are not at risk of contracting HIV.


By Siphosethu Stuurman
5 July 2011

Recent research shows that lesbian and women who have sex with both women and men are a marginalised group that is increasingly vulnerable to HIV and AIDS.

A pilot study which looked at the health experiences and needs of a sample of 500 lesbian and bisexual or women who have sex with both women and men in four Southern African countries, including South Africa, found that 71% of the cohort group was at risk of HIV infection. 

“Seventy-one percent of lesbian women have been at risk. Those risks include, for example, engaging in transactional sex, engaging in non-consensual sex with both men and women”, says Zethu Mathabane from the Human Sciences Research Council (HSRC).

The study revealed that 30% of women accessed through the survey had unprotected sex because they believed they were not at risk of contracting HIV.

“There are general misconceptions in the general population that lesbian women are not at risk of HIV. What we have managed to do through this research is to demonstrate that lesbian and bisexual women are actually at risk”, she says.

Over 50% of the women surveyed said they had sex only with women over their life-time, while more than 15% of the women acknowledged bisexual behaviour.

The study suggests that women who have sex with women have an increased chance of contracting HIV if they have sex with men as well.

 Dr. Vicci Tallis, from the Open Society Initiative for Southern Africa (OSISA), says more research is needed to prove the validity of these perceived risks. Tallis also raised concern that the study found that a small, yet significant number of women who are exclusively lesbian are HIV-positive.

“One cannot assume that lesbian women do not have sex with men because they do. But what was surprising for us was that over and above that there were substantial numbers of women who reported that they had never had sex with men before, but were HIV-positive. So, that puts questions into our minds about risks or transmission between two women”, she says.

Some of the risks for women who have sex with women include sexual practices such as the use of sex toys that are not cleaned properly. 

“I think it’s very clear that when we talk about lesbian women, bisexual women, it’s a very diverse group and there are a lot of complexities around sexual practises, identity demographics. Lesbian women are infected with HIV, and I think that was one of the key things we wanted to get out of this study, to say: “Yes, there are lesbians who are HIV-positive”, says Dr. Tallis.

She says the study also showed that there are real barriers to accessing health care services for lesbian and bisexual women.

“Lesbian and other women who have sex with women do not have adequate information and services relating to HIV. I think it also shows that lesbian women want and need access to general health services and specific HIV and AIDS health services. We have got experiences documented of lesbian women who get negative treatment when their sexuality is known and we think it’s clear that lesbian women are at risk of HIV”.

She said that national programmes on HIV and AIDS need to start addressing the needs of lesbian and bisexual women who continue to be marginalised in the country’s response to the epidemic.

“There is a belief - and it’s a spoken belief - that there is no risk and, therefore: Why should we even think about you? We want an acknowledgement of risk.  That acknowledgement of risk has never been there”, concludes Dr. Tallis.

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Safe Sex Elusive for Many Women. 20/6/11

Most women still find it difficult to negotiate safe sex with their partners 


By Siphosethu Stuurman
20 June 2011

Most women still find it difficult to negotiate safe sex with their partners. The problem is even more prevalent among women who are economically dependent on men. Some institutionalised social and cultural norms also fuel the challenge.

Ruth Mokoena, a 30 year-old married woman from Johannesburg, believes that age difference plays a major role in whether a woman is able to negotiate safe sex in the relationship.

“Women do find themselves in a situation whereby negotiating safe sex in the bedroom becomes a burden and they end up giving in. You get some ladies where there is an age difference between the two people… and I found that the younger woman (most of the time… it’s a younger woman) has a lot of difficult time convincing the guy to use a condom”, she says.

Ruth reckons that she probably would have had a similar problem had her partner been older.   

“I found that with me and my husband we’re the same age and we think along the same lines. It tends to be much easier”, says Mokoena.

Moses Mabala, a 31-year old male from Johannesburg, also shared his thoughts on the subject.

“Sometimes men will force their way through to have unprotected sex. A woman will be given no opportunity to stand up for herself, which is a wrong thing to do”, he says.

Zuzimpilo Clinic’s Dr. Limakatso Lebina said ascribed this to a lack of safer sex methods that put power into women’s hands. She says this and other factors, such as the economic and cultural status of women contributes to women’s struggles to negotiate safe sex with their male partners.

“It is definitely difficult for ladies to negotiate safe sex. Unfortunately, the current safer sex methods that are there highly depend on the man to say ‘yes’. And with the relationships always being that the woman will be inferior for whatever reason, whether economical or cultural, then it becomes very difficult, especially in the dim light for a lady to say ‘where is the condom?’ ”, says Dr. Lebina.

Dr. Catherine Ongunmefun from the Health Systems Trust also weighed in on the subject.

“There is the issue of cultural practises that are also not helping women. When it comes to lobola payments... As a woman, a man pays lobola for you and that means you have to submit to that man. It’s not going to be easy for you to say: ‘maybe, we need to use a condom’.  And also, we know that in South Africa we have a very high rate of gender violence, which means women are being abused by their partners.  You can imagine if you have been just beaten as a woman there is no way you are going to say: ‘Can we use a condom’?”, Dr. Ongunmefun says.

Dr. Ongunmefun went on to say that women need to learn to empower themselves.

“Somehow, I think women give in easily. Maybe because they don’t have a choice. But if you are economically empowered as a woman and you have a good job, you can negotiate with your partner.  You have to find a way not to depend on a man in a relationship.

 As a woman you need to empower yourself, respect yourself and say: ‘If you are not going to use a condom, then I won’t have sex with you’,” she says.

According to Mbuyiselo Botha of the Sonke Gender Justice Network, often, men view sex as an act of power. With that comes the need to be in control. As a result, the manner in which sex occurs, including whether precautions are taken or not, largely depends on them.

“A lot of men in our workshops would say ‘condoms don’t make me feel like a real man’. As you go on to ask: What does that mean? It’s that ‘I may not have sexual satisfaction, I need to know that I am in-charge, in control and she must in fact feel me and hear me’,” says Botha

Botha went on to say that men have a notion of invincibility. They tend to believe that HIV and any other sexually transmitted diseases only affect women.

“There is the thinking that HIV it’s not6 a problem for us men. It’s in fact women because there is also a notion that women are loose, they have loose morals, they need to be controlled and they need to be contained”, he says.

Dr. Ongunmefun says there is still a lot of work that needs to be done to change the mind-set of men.

“I think men are generally ignorant, they pretend to know but they don’t really know!  They are aware that there is HIV out there, but they never internalise the fact that they have to do something about it themselves. We see millions of people dying out there, but what are you doing as a man?  You are contributing to the problem as men by not going to test, you need to know your status”, she says.

Moses Mabala says there is still hope that men can change. He says there needs to be a new culture of fathering young boys to make them become better men of the future. 

“Fathers can contribute to the whole society in raising their boys  or their sons in a manner that does not only mean sex is everything... but also learning how to respect a women and learning how to be a man  because at the end of the day it is us men that force actions on women”, concludes  Mabala.

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MSM, Mental Health & Substance Abuse. Living with AIDS # 475. 2/6/11

South Africa: HIV infection is more likely to cause mental health and substance abuse problems among young men who have sex with men than in heterosexual men.


By Khopotso Bodibe
2 June 2011

At a recent conference in Cape Town, it emerged that HIV infection is more likely to cause mental health and substance abuse problems among young men who have sex with men than in heterosexual men.

HIV infection levels among gay men or men who have sex with men in South Africa and many parts of the continent are generally higher than among heterosexual men. Studies suggest that there is an HIV prevalence of about 20% among men who have sex with men or MSM, while the prevalence among men in the general population is at 14.5%. Similarly, substance abuse is higher among men who have sex with men.

“A young men’s survey   showed us that 66% of young MSM reported illicit drug use. Gay men are more likely than their heterosexual counterparts to use alcohol and drugs and initiate these at an earlier age”, says Dr Greg Jonsson, a psychiatrist at Chris Hani Baragwanath Academic Hospital, south-west of Johannesburg.

Fellow psychiatrist, Dr Kevin Stollof, who works at the Ivan Toms Men’s centre in Cape Town, concurs. Between the beginning of 2010 and last month, Dr Stoloff has had over 180 mental health consultations. About 71% of the consultations have been with HIV-positive men. He says the substance abuse, due to HIV infection, is often accompanied by certain mental disorders. 

“Generally, if you’re HIV-positive, you’ve got double the chance of having anxiety, depression and substance abuse. And, of course, if you’re MSM, that’s higher. In addition to seeing those common mental disorders, we see HAND. This is HIV-associated Neuro-cognitive Disorder. These are problems in the brain with thinking, with concentration, with memory and with complex tasks like planning, monitoring one’s own social behaviour, abstract thinking, making meals, etc. So, we see a whole range of problems from minor subtle problems – forgetting simple facts, forgetting names, slight clumsiness along to the middle of the road cognitive disorder to the severe dementias”, Dr Stollof says.

Often, these young men are seen to go into a downward spiral. Many are not even aware of their HIV status and invariably continue to be at risk. 

“There’s less fear of HIV. There’s lack of awareness about HIV status. About 18% of young MSM know their status. There really is a propensity towards depression and substance abuse, causing lowered self-esteem and various other issues. Young people are more likely to report depressive symptoms and less likely to use counselling or medication for their psychiatric conditions. They are also more likely to report heavy alcohol and also, unprotected insertive and receptive anal intercourse. We know that psychiatrically ill adolescents are more likely to be sexually active, have more partners than those without psychiatric illnesses”, says Dr Jonsson.

“Therefore, we really need to spend time identifying psychiatric illness and treating them”, he adds.

Dr Jonsson says two issues cause this. Both are stigma-related. One is stigma as a result of one’s sexual orientation and the other stigma induced by HIV infection. 

“Internalised homophobia is very prominent - negative self images, concerns about public attitudes, real fears about disclosing one’s status.  Higher levels of HIV stigma are associated with negative outcomes, especially romantic loneliness, poor self-esteem, lack of social support. And then, also, sexual minority stigma associated with emotional and behavioural problems, anxiety, suicide and substance abuse”.

Chief Executive Officer of Anova Health Institute, Dr James McIntyre, agrees that substance is a problem.

“Clearly, we know from experience in the US that what has driven a lot of the almost resurgent HIV infections in some areas is the use of crystal meth or tik. We’re seeing in South Africa an increasing use of tik. We’re seeing in South Africa an increasing usage of injected drugs. It’s a vicious circle of shame and guilt and stigma and discrimination and low self-esteem and then drug use and then back into a circle that, unfortunately, often involves HIV as well. We’re aware of it. But this is not something that’s only being seen in MSM”, Dr McIntyre says.

These turn of events may lead to young men engaging in sexual activities prematurely. Often, there is no support network for these youngsters. The health care sector is also ill-prepared to cater to their needs.

“We need to start looking at the youth that are prone to coercive and unprepared sex. Many health care workers don’t know about the diversity of young MSM. And many psychiatrists don’t really know. So, what we really have to do is start educating other health care workers. We also need to look at the socio-economic determinants fuelling HIV transmission”, says Dr Jonsson.

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Gender-based Violence Compromises HIV Prevention. 4/5/11

HIV and sexual and gender-based violence have a reciprocal relationship as women who are victims of violence are at high risk of infection while those living with HIV are more vulnerable to violence

4 May 2011

HIV and sexual and gender-based violence have a reciprocal relationship as women who are victims of violence are at high risk of infection while those living with HIV are more vulnerable to violence, an official with the Namibia Planned Parenthood Association has said.

Ingrid Elvevag, the NAPPA technical advisor, said it was important to address SGBV [sexual and gender-based violence] in any strategy that aims to reduce HIV prevalence. 'Despite the existence of numerous policies designed to protect women and girls from SGBV, the phenomenon remains highly prevalent in Namibia and is fueling the continued spread of HIV,' Elvevag told Parliamentarians, representatives of civil society organizations, sex workers and sexual minorities at a recent workshop to discuss HIV prevention in the context of human rights. She attributed policy failures to lack of community awareness regarding fundamental human rights and the provisions of the law relating to SGBV, as well as poor response skills among officials dealing with survivors of abuse.

'Rectifying this situation requires measures that ensure that existing legislation is effectively communicated at all levels, and that financial and logistical support is provided to ensure that SGBV-related policies are in fact implemented,' she said. She explained that SGBV included a wide-range of human rights violations such as: physical and sexual violence, emotional abuse, harassment and intimidation, human trafficking, harmful traditional practices, and economic abuse. 'Economic abuse is often overlooked as a form of SGBV. Economic vulnerability makes women especially vulnerable to other forms of abuse. 'Male control over household finances may force women to exchange sexual favours for money or gifts to meet basic needs.'

Elvevag said physical or emotional abuse reinforces male dominance in a relationship and prevents women from negotiating safe sex or leaving unfaithful partners. '(It) can limit a women's ability to access health services, maintain adherence to ARV treatment, or limit a woman's choice on how to feed her baby.' With respect to sexual violence, Elvevag said it exposes the victim to the perpetrator's sexual networks.

Sexual violence includes coercion, molestation and rape. Turning to culture, Elvevag said some people still maintained practices that were harmful to women or increased their vulnerability to infection. 'Preferences for dry or wet sex encourage vaginal use of herbs which lead to increased risk of HIV transmission due to vaginal tearing,' she said, adding that virginity testing in some cultures encourage young girls to engage in unsafe alternative sex such as anal sex. Elvevag said there were reciprocal linkages between SGBV and HIV.

'Evidence exists that living with HIV can constitute a risk factor for SGBV, with many people reporting experiences of violence following disclosure of HIV status, or even following admission that HIV testing has been sought. 'Thus a vicious cycle of increasing vulnerabilities to both SGBV and HIV can be established,' she said. She added that many women were still trapped in subordinate positions across cultural groups and were economically dependent on men. Gender stereotyping is another challenge, with agents of socialization such as the family, school and church narrowly defining gender roles.

'Women are supposed to be obedient, please their husbands, tolerate extra-marital affairs and violence,' she said, adding that alcohol and drug abuse were also problematic factors.

Over the years there have been calls to empower women with knowledge about their rights, leading to the production of reams of documents and holding of numerous workshops at which women are taught their rights.

According to Elvevag, it is clear that knowledge alone offers little protection against SGBV.

'Even where knowledge exists women – especially young women – often feel unable to demand their rights.

'Knowing about your rights is not the same as being able to demand your rights.'

The latest Demographic Health Survey for Namibia shows that 95 percent of girls between the ages of 15 and 19 have knowledge about modern contraceptive methods.

That notwithstanding, youth pregnancy rates in the country remain extremely high, with data showing that 20 percent of 17-year-olds, 35 percent of 19-year-olds and 57 percent of 20-year-olds have already given birth.

In April 2008, staff at Gammams Water (Treatment) works in Windhoek estimated that they discovered an average of 13 bodies of newborn babies each month in human waste flushed down toilets.

Contraceptives are not difficult to access in Windhoek; they are available for free at all government and NAPPA clinics and so the incidence of illegal abortions may indicate that there is a large number of girls and women who still cannot negotiate safe sex.

Elvevag bemoaned poor response skills among officials dealing with victims of abuse and the lack of male involvement in issues related to sexual and reproductive health.

She said civil society organizations should play a key role in addressing SGBV through counseling, assistance with legal and/or health referrals, providing shelter and community education to raise awareness, advocacy and playing watchdog.

She warned that empowerment strategies targeting only women would not change male behaviour.

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Five Ways to Reduce Women's Vulnerability to HIV. 8/3/11

Education, Access to reproductive health services, Ending gender violence, Economic empowerment, and Involving men

8 March 2011

Nairobi- As the world celebrates the 100th anniversary of International Women's Day, women and girls across the globe continue to be disproportionately affected by the AIDS pandemic - HIV is the leading cause of death and disease among women of reproductive age worldwide.

IRIN/PlusNews presents five important ways to reduce women's vulnerability to HIV:

Education: According to UNAIDS, illiterate women are four times more likely to believe there is no way to prevent HIV infection, while in Africa and Latin America, girls with higher levels of education tend to delay first sexual experience and are more likely to insist their partner use a condom.

Educating girls has the added advantage of delaying their marriage and increasing their earning ability, both of which reduce their vulnerability to HIV. Educated women are also more likely to access health services for themselves and their children, and to oppose negative cultural practices such as female genital mutilation/cutting (FGM/C).

Access to reproductive health services: In many developing countries, women have very limited access to vital reproductive health services. A combination of biological and social factors means women are more vulnerable to sexually transmitted infections (STIs), which, if left untreated, increase their vulnerability to HIV.

Women living in humanitarian crises are particularly vulnerable to sexual violence and require services such as free, easily available condoms and safe blood for transfusions.

Improving access to reproductive health services enables women to make informed choices in determining family size and preventing mother-to-child HIV transmission.

Ending gender violence: One in three women has been beaten, experienced sexual violence or otherwise abused in their lifetime, according to the UN; one in five will be a victim of rape or attempted rape. More often than not, the perpetrators are known to the women.

Practices such as early marriage, FGM/C and human trafficking all increase women's vulnerability to HIV, but more accepted forms of violence, such as marital rape, also play a large part in increasing women's HIV risk.

According to UNAIDS, investment in HIV programming policies and addressing gender inequality and gender-based violence will help to achieve universal targets of HIV prevention, treatment and care.

Economic empowerment: In his book, Global Problems and the Culture of Capitalism, Richard Robbins states that women do two-thirds of the world's work but receive 10 percent of the world's income and own just own 1 percent of the means of production.

Poverty prevents poor women from controlling when sexual intercourse takes place and if a condom is used, and often forces women into risky transactional sex to feed themselves and their families.

According to a 2010 US Government study, empowerment activities such as micro-finance give women access to and control over vital economic resources, ultimately enhancing their ability not only to mitigate the impact of HIV, but also to be less vulnerable to HIV.

Involving men: More often than not, men control the dynamics of how, when and where sex happens. Encouraging more men to use condoms consistently has the knock-on effect of protecting their sexual partners from unwanted pregnancies and sexually transmitted infections, including HIV.

Men are less likely than women to seek health services; in the case of men involved with multiple women, this means STIs remain untreated for long periods while their female partners are also at risk of infection.

Teaching boys and young men to respect women, to be more involved in family activities and to avoid negative behaviour such as gender violence and alcohol abuse helps groom a generation of men who are less likely to take risks that endanger themselves and their families.


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Global / Women's Rights and HIV: GCWA Statement on International Women's Day, 2011. 7/3/11

On this International Women's Day, our commitment to women and girls is stronger than ever

7 March 2011

This year we are celebrating the 100th year of International Women’s Day. In the last century, considerable progress has been made in regards to women’s rights, however significant challenges remain. Around the world, women and girls continue to have unequal access to education, training, science and technology, and decent employment. In 2010 women accounted for half of the 30 million people living with HIV, represented 70% of the world's poor and two-thirds of the currently 130 million children not in school are girls. In sub-Saharan Africa, 60% of people living with HIV are women and in the majority of countries the epidemic shows the most growth among women between the ages of 15 and 24.

Almost two-thirds of women in the developing world are either self-employed or unpaid family workers in the informal economy. In the context of HIV, women carry a significant burden of care – a labor that tends to go both unrecognized and unpaid. In developing countries, women consistently earn less than men for similar work, and have less access to credit and lower inheritance and ownership rights than men do. All these challenges are accentuated in the context of HIV, where women face challenges in accessing services, education and employment, are subjected to violence, stigma and discrimination, as well as legal barriers such as inheritance laws which discriminate against women.

As we commit to working towards the achievement of equal access to education, training, science and technology, a focus on upholding women’s rights in the HIV response is essential. Promoting programmes that challenge structural gender inequalities is crucial in shifting gender relations, and this must include investing in education for women and girls. Access to education, including comprehensive sexuality education, must form a key part of efforts to prevent HIV, as well as empower women and girls, including those living with HIV.

At the same time, training and support for women to access employment is a crucial step in the empowerment of women. In the context of HIV, women who have access to fair employment are often better equipped to leave relationships and settings where they may be discriminated or subjected to violence.

The 2011 High Level Meeting on HIV/AIDS this June provides a historic opportunity to make concrete commitments to women and girls, building on the priorities outlined in the UNGASS Declaration of Commitment on HIV and AIDS and the Political Declaration, the Beijing Platform for Action, the Programme of Action from the International Conference on Population and Development (ICPD), the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the Millennium Development Goals (MDGs).

100 years since the establishment of International Women’s Day, we must come together to deliver on a world in which women and girls, especially those living with HIV:

-have equal access to education, training, science and technology, and decent employment;
-are equally and effectively engaged in all decision-making processes that affect their lives;
-have their human rights, including sexual and reproductive health and rights, respected and upheld at every level, irrespective of age, HIV status, sexual orientation, occupation, or other;
-have access to comprehensive HIV and AIDS prevention, treatment, care and support that reflects the reality of the lives of women and girls;
-are able to access the resources that they need in order to achieve their goals.

On this International Women's Day, our commitment to women and girls is stronger than ever. By building and strengthening partnerships, and jointly advocating for the rights of women and girls in the context of HIV, the Global Coalition on Women and AIDS will strive to make this vision a reality.

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Women Help Stop the Spread of HIV/AIDS. 26/1/11

Ttens of thousands of Burkinabé have benefited from PAMAC's nationwide work to raise public awareness on HIV and AIDS.

26 January 2011

Burkina Faso - Assiétou was pregnant with her third child when she discovered that she was HIV positive.

"I thought it was the end of the world," she recalls. "I immediately thought about my husband and I was very worried about his reaction. In the end, I summoned up all my courage and went to talk to him."

Assiétou's husband, Laouali, immediately agreed to go to a voluntary screening centre, where he found out that he is also HIV positive.

Today, they both receive free treatment from the UNDP Support Programme for Associations and NGOs (Programme d'appui au monde associatif et communautaire) otherwise known as PAMAC.

The broad-based programme was set up by UNDP in 2003 on request from the National AIDS Council. It is made up of 142 civil society organizations and six national networks working to prevent the spread of HIV and AIDS in the country. This nationwide mobilisation has helped reduce the HIV and AIDS prevalence rate from 7 percent in the 1990s, to 2 percent in 2007.

Assiétou was tested thanks to a group of women volunteers who are part of the PAMAC network, and who conduct informal discussions with people living in different villages about the risks of HIV.

They also organise plays and film screenings followed by debates, raising issues such as the importance of wearing a condom, HIV testing and preventative action.

Assiétou and Laouali are among tens of thousands of Burkinabé who have benefited from PAMAC's nationwide work to raise public awareness on HIV and AIDS.

Since January 2009, 175 women's groups have been involved in 1,345 educational sessions, reaching some 150,680 people, more than half of whom are women. 1,560 people have received HIV screening tests, and 30 individuals who tested positive are currently receiving treatment in the areas covered by the women.

More broadly, in addition to these advocacy efforts, during 2010, the PAMAC network provided increased access to information, counseling and testing services, and home-based care to more than 74,000 HIV patients - almost half of whom are orphans and disadvantaged children.

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No Link Found Between HIV and Intimate Partner Violence among Women in 10 Developing Countries. 1/11

More research is needed to understand the circumstances

January 2011

Intimate partner violence (IPV) has been reported in previous studies to increase women's risk for HIV infection. However, a new study by HSPH associate professor S.V. Subramanian and doctoral student Guy Harling found that IPV is not consistently associated with HIV-risk worldwide. The researchers examined the relationship between women's self-reported experiences of IPV in their most recent relationship and their laboratory-confirmed HIV status in ten low- to middle-income countries. Data for the study, which involved a cross-section of women aged 15–49 years, came from the most recent Demographic and Health Surveys in Dominican Republic, Haiti, India, Kenya, Liberia, Malawi, Mali, Rwanda, Zambia and Zimbabwe. 

The study appeared online in PLoS One on December 8, 2010.

Further research is needed to determine whether the relationship between IPV and HIV in specific countries differs depending on whether the study population is clinic-based or uses a national sample, according to the researchers. Additionally, more research is needed to understand the circumstances in which IPV and HIV are and are not associated with one another.


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Study Says Race, Gender and Geography Predict Poorer Health With HIV. 18/1/11

State of Health with HIV result of socioeconomic conditions

18 January 2011

HIV-positive women, nonwhites and people residing in the Southern United States had poorer health than HIV-positive men, whites and people residing outside the South—despite having nearly equal access to antiretroviral (ARV) therapy. These data, published online January 18 in The Journal of Infectious Diseases, suggest there might be significant challenges in achieving the goals of the 2010 National HIV/AIDS Strategy.

Disparities in HIV care, overall health and risk of death between women and men, and between white and nonwhite individuals in the United States have been noted in multiple studies. In particular, such studies have shown that race and gender affect multiple aspects of HIV health and treatment, including late entry into care and HIV testing, later initiation of ARV therapy and poorer adherence to treatment. Few studies have looked, however, at the intersection of race and gender and simultaneously examined how geography may contribute to differences in health among people with HIV.

To explore these factors, Amie Meditz, MD, from the University of Colorado in Denver, and her colleagues examined data from the Acute Infection and Early Disease Research Program (AIEDRP) cohort study, which took place primarily in North America and Australia between 1997 and 2007 and followed 2,277 individuals newly infected with HIV.

Most of the participants were men—only 5.4 percent were women. There were also differences between the male and female participants. Most of the men were white (77 percent), while the majority of women enrolled were nonwhite (55 percent). Nonwhite was defined as either black, Hispanic or other races. Women were also far more likely to be from the Southern United States and to have a history of injection drug use than men.

Generally, women started the study with lower viral loads and higher CD4s than men, and they reported fewer symptoms—such as fever or rash—during the earliest stages of infection.

Though viral load and CD4 counts differed by gender and race initially, these differences largely disappeared within six months after a person started ARV therapy. There remained, however, significant differences in other measurements of health and HIV disease progression.

White women were more likely to start ARVs than white men, and white participants were more likely than nonwhite participants to start ARVs at any time over an average follow-up time of four and a half years. Participants from the Southern United States were also less likely to start ARVs during the follow-up period than participants residing outside the South. This remained true even after controlling for people with a CD4 count of less than 200 before 2004 and less than 359 after 2004. In 2004, the U.S. HIV treatment guidelines began recommending that treatment be started when CD4s dropped below 350, where previously the threshold had been 200 CD4s.

Looking at race and sex in regards to health status, women (particularly nonwhite women) had more HIV-related health problems than others when controlling for most factors, including a history of intravenous drug use. Nonwhite women were twice as likely as nonwhite men, three times as likely as white men, and more than eight times as likely as white women to have a CD4 count under 200 at any time point. Women (overall) were also more than twice as likely as men to have a non-AIDS-related health problem, and nonwhite women had more AIDS-related and non-AIDS-related problems than all other groups.

The authors note that such differences have not been commonly observed outside of the United States but have commonly showed up in U.S. studies. They write: “Collectively, these data suggest that sex differences in HIV related morbidity observed in this study are not biologically based but are the result of socioeconomic conditions specific to the United States.

The authors acknowledge the limitations of their study. In particular, there were few women in the study and few nonwhite men. Even the geographical data were unbalanced: 58 percent of the men enrolled were in Western states, compared with only 7 percent of the men enrolled residing in the South. This limits the conclusions that may be drawn from the study, though much of the data are consistent with other studies examining race and gender in HIV care and treatment.

People in the study were also followed much more closely than people in the average medical setting and were more likely to start and stay on ARV therapy than has been observed in other studies. This, the authors warn, means that the study probably significantly underestimated the disparities in health they found: especially those by sex, race and region.

In all, they explain, “Data from this study suggest that differential use of [ARV therapy] cannot entirely explain elevated [illness] in nonwhites and women, but that socioeconomic factors associated with residence in the South and nonwhite race may play a role.”

According to an accompanying editorial, the study results suggest that the discrepancies they found in health and mortality “threaten the success” of the goals of the National HIV/AIDS Strategy released in 2010. Those goals include having all people with HIV know their HIV-status and be engaged in care—both for their own health and as a means to reduce transmission to others.

“Socioeconomic factors…represent complex challenges that are beyond the traditional influence of public health. A collaborative policy and research effort across all levels of community, government and science must be undertaken if we hope to meet the goals of the National HIV/AIDS Strategy,” conclude the editorial’s authors.

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Gender News 2010

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In Europe, Seven in Ten HIV Diagnoses are in Men. 6/12/10

Just under 26,000 people were diagnosed with HIV in the European Union in 2009


By Roger Pebody
6 December 2010

Just under 26,000 people were diagnosed with HIV in the European Union in 2009 and 72% of those diagnosed were men, researchers report in the December 2 issue of Eurosurveillance. Rates of infection in gay and bisexual men are on the rise, but are falling in heterosexuals.

The report comes from the European Centre for Disease Prevention and Control, which collates data from national public health bodies. There are some inconsistencies in the ways in which these bodies collect information, there are reporting delays and some data are missing. Nonetheless there is some information from all of the 27 European Union countries except Austria, and the two non-EU countries of Norway and Iceland are also included in the analysis.

Across Europe, the average is for there to be 5.7 new diagnoses per year for every 100,000 people in the population. However this rate is far higher for men (8.3 per 100,000) than for women (3.2 per 100,000). Moreover some countries have diagnosis rates significantly above the average - Estonia (30.7), Latvia (12.2), the United Kingdom (10.7) and Belgium (10.3).

Looking at trends since 2004, the overall diagnosis rate in the proportion is broadly stable. However, the proportion of men diagnosed has risen (from 64% to 72%). This rise reflects a 24% increase in diagnoses in gay and bisexual men (from 7263 men in 2004 to 8974 in 2009), occurring at the same time as a 24% fall in diagnoses in heterosexual men and women (from 13,148 to 9975).

The number of diagnoses in injecting drug users has fallen by 40% - from 1952 to 1171 cases. However in several East European countries, injecting drug use remains the predominant mode of transmission.

Over this five year period, HIV diagnoses have tripled in Bulgaria, Iceland and Slovakia, and doubled in Hungary and Slovenia. They have decreased by more than 20% in Denmark, Estonia, Italy, Luxembourg and Romania.

Returning to the 2009 figures, only eleven countries supplied enough information on CD4 counts to provide estimates of the proportion of people who were diagnosed late (with a CD4 cell count below 350 cells/mm3). However in ten of these countries the results were very consistent - between 40% and 52% were diagnosed late. The one honourable exception is Luxembourg, where only 24% were diagnosed late. Individuals whose country of origin is outside Europe are more likely to be diagnosed late than Europeans.

The authors say that the figures on late diagnosis, whilst incomplete, “suggest that access to testing and treatment needs to be improved among those at risk”. Accordingly, the European Centre for Disease Prevention and Control has issued guidance on increasing the uptake of HIV testing. Among this document’s core principles are that political commitment is required, HIV stigma must be tackled and legal obstacles removed. HIV testing should be normalised and treatment made available for all, including undocumented migrants. Moreover, each country needs its own national HIV testing strategy, developed with the involvement of a wide range of stakeholders.

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HIV & AIDS in Africa: The Female Face of the Pandemic. 2/12/10

You don’t ask the husband where he has been, or where he is going

Consultancy Africa Intelligence

Tumelo Itumeleng Nxumalo
2 December 2010 

In sub-Saharan Africa, women’s health and nutritional status is comparatively worse than that of men and also one of the lowest worldwide. The World Health Organization (WHO) reports that African women score the lowest rates in almost every health indicator category, and particularly with regard to HIV & AIDS. African women record the highest HIV & AIDS prevalence and maternal mortality rates. Nearly 90% of the world’s maternal transmission of HIV infections to newborns occurs in sub-Saharan Africa. According to UNAIDS, the region accounted for 67% of HIV infections globally in 2008. Women alone accounted for 60% of those estimated African HIV infections. Overall, 70 % of all women living with HIV & AIDS worldwide are in Africa. African women are the face of the HIV & AIDS pandemic worldwide.(2)

This CAI discussion paper explores the HIV & AIDS pandemic in African women – especially the causes of the disproportionate male and female basic health indicators and the need to develop appropriate and effective interventions that work towards the reduction of HIV & AIDS in African women. 

The drivers of the female HIV & AIDS pandemic

Socio-cultural, legal and economical factors contribute to female vulnerability to HIV & AIDS. Females are physiologically susceptible to heterosexual HIV transmission during unprotected sexual encounters. The extensive surface area of the mucous membrane in the vagina and on the cervix increases susceptibility to HIV infection through viral entry via tears and abrasions. This is particularly the case in younger women, whose vaginal lining is thinner, and most prone to abrasions.  In addition, semen deposited into the vaginal canal, which retains a high concentration of semen even some time after the intercourse, facilitates viral penetration over a longer time period.

- Mobility and Migration

Most of sub-Saharan Africa is poverty-stricken and/or has experienced social upheavals spurred both by economic downturns and by political instability and warfare. This leads to pervasive mobility rates and extensive migration. 

South Africa is the most common destination of an influx of migrants from poorer and war-torn African countries. People from predominantly rural areas relocate to greener city pastures.  South Africa’s Gauteng province especially is an urban hub and melting pot of diverse African cultures, characterised by migrant labourers. These migrant labourers work at menial jobs which do not afford them the means to relocate with their families. Therefore they generally leave their spouses behind, with both parties often entering into new sexual relationships for both psychological and material gain. This reinforces cultural norms that exacerbate female vulnerability to HIV & AIDS.

- Cultural expectations

Gender-based constrains also contribute to gendered economic disparities.  Gendered cultural expectations in particular reinforce the female face of HIV. The decision of whom to have sex with, for what purpose, when and how lies all too often exclusively with the male –regardless of marital status. In such male-dominated situations, women cannot negotiate safer sexual practices. For example, in Setswana culture a man who does not express his masculinity and sexual virility by having concurrent relationships is not perceived as a man. Society sanctions this and expects women to be submissive to their spouses. Lack of submission carries with it punishment, including permanent expulsion from the marital home, with devastating implications on lobola(3) and the custody of minor children. A complaint from a spouse slighted by the husband’s infidelity receives ridicule and comments such as:

- “Monna ga a bodiwe gore o tswa kae”
(You don’t ask the husband where he has been, or where he is going);
- "Monna ke poo ga e agilwe lesaka"
(A man is a bull which cannot be confined but must be let loose);
- "Monna ke thotse o a nama"
(A man is a seed which multiplies);
- "Monna ke selepe, o stamaya a rema, o a adimangwa"
(A man is an axe which must go about chopping, and therefore must be shared).

If the woman is caught transgressing her martial fidelity and is ‘lucky,’ she may be temporarily sent back to her family for conformity counseling (go laiwa) to be counseled on being a good wife, while the lover (the bull that broke into the kraal) is charged with trespassing and ordered to pay damages to the aggrieved male and his family for his indiscretion by customary law. Women in this context are in no position to negotiate safer sex even when they aware of their spouse’s infidelity. 

- Trans-generational/transactional sex

In addition to these gendered norms which contribute to the female face of the HIV pandemic in sub-Sahara, another driver of infection is trans-generational/transactional sex. Young females usually accept the advances of older males (sugar daddies) for financial and material gain. Such relationships bring gifts and money for the purchase of designer labels, cell phones and even better accommodation, often not only for the women herself, but also for her entire family. Women in such a scenario are in no position to negotiate safer sex.

The way forward in fighting the feminisation of the African HIV & AIDS epidemic

From a legal and government point of view there is a need to strengthen legal  frameworks and processes that promote women’s rights and eliminate gender inequality in the context of HIV & AIDS – particularly in relation to women’s property and inheritance rights, right to education, career and progression in the workforce. It is important that interventions facilitate a decisive strategy that secures women and girls rights to property and inheritance, as well as access to educational and employment opportunities.  

 Economic gender imbalances that are catalytic to the rise of the female-HIV gendered epidemic may be mitigated by interventions that empower women to be economically independent. Bursaries, scholarships, and internships empower girls to enter careers traditionally reserved for males. Facilitating an enabling, supportive environment that nurtures female business and agricultural ventures is another way. This is to motivate economic self reliance among African women. Incentives that foster female access to micro financing services and community-banking lending services to expand their business operations further empower women. To facilitate sustainability and harness female creativity for maximum potential, mentorship programmes and awards for women making inroads into this field could be used as an incentive.

Laws against gender discrimination, inequalities, violence and sexual coercion should be updated and enforced as part of national HIV & AIDS strategies, in order to reassert the human rights of women as a core part of universal human rights.  Interventions that seek a redress to century-old beliefs and unfavourable social norms that unfairly predispose females to contracting HIV must be identified, and appropriate measures developed to counteract them. The participation of female civil groups must be recognised as crucial. Gender imbalances within society must be addressed –especially in the fields of access to education, inheritance and property ownership rights. These imbalances disadvantage women economically. 

Culturally entrenched gender norms which increase women and girls’ vulnerability to HIV & AIDS need to be revised. Education and awareness programmes must encourage responsible sexual behaviour and discourage myths and misconceptions that fuel the spread of HIV & AIDS. Communities could be facilitated on gender inequalities and be incorporated into designing a comprehensive, step-by-step family and community-focused strategy of ending female gender inequities. This intervention should be designed and developed to accommodate the uniqueness of the target community i.e. it should be culturally sensitive to a specific community. The intervention must incorporate, right from conception, relevant stakeholders such as women groups, male groups, HIV & AIDS activists, traditional leadership, civil organisations and the government. The best people to determine the direction of the intervention are the members of the community themselves. For instance, the registration of a network of positive women living with HIV & AIDS in sub-Saharan Africa, and even in the broad African continent, may facilitate the mitigation of a range of issues that place women at risk of HIV transmission or prevent women from seeking timely access to preventive and treatment programmes, effective legal representation, gender-based human rights violations, and the promotion of sustainable HIV interventions.


Gender issues cannot be excluded in campaigns that seek to reduce the vulnerability of women to HIV infection. Gender relations and inequalities are core to the demographic disparities in HIV prevalence.  HIV & AIDS programmes must be balanced in their community services.  They must work towards a reduction in gender-based violence and coercion. Male norms and behaviours must be addressed. There is need for an increase in women’s legal protection. Finally, to reduce female economic dependence on males, there is a need for programmes that aim at facilitating an increase in girls’ and women’s access to educational opportunities, income, and productive resources. Most importantly, HIV & AIDS prevention, care and treatment activities must be addressed as gender inequalities.



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Study Shows War on Women Begins at Home. 29/11/10

One in four women in the province said they had experienced sexual violence in their lifetime

Mail & Guardian

By Faranaaz Parker
29 November 2010

Almost 80% of the men in Gauteng admit to perpetrating some form of violence against women. This was revealed through a prevalence survey on gender violence conducted by the Medical Research Council (MRC) and the non-governmental organisation Gender Links.

The preliminary findings of the study, titled The War at Home, was released at the start of the 16 days of activism for no violence against women and children. "The survey in South Africa's most densely populated and cosmopolitan province shows that while political conflict in the country has subsided, homes and communities are still far from safe, especially for women," said the authors.

South Africans and the international community were shocked last year when the MRC revealed that one in four men surveyed in the Eastern Cape and KwaZulu-Natal admitted to committing rape. But this new survey shows that gender-based violence may be even more widespread in Gauteng than in other provinces. More than one in three men in Gauteng admitted to perpetrating sexual violence.

Rachel Jewkes, director of the Gender and Health Research Unit at the MRC, pointed out that only 18% of rapes were perpetrated by partners. "This is a unique and special feature seen in South Africa, that to rape a stranger or acquaintance is more common than to rape an intimate partner," she said. In most countries, rape is usually perpetrated by someone close to the victim.

"We're often told by the media and others that we're exaggerating the problem, that abuse is not rife. But only 21,7% of men said they'd never perpetrated a form of violence against women," said Jewkes. She said this said much about ideas of sexual entitlement and gender hierarchy in South African society.

Overlapping forms of violence

The survey data was gathered by interviewing a representative sample of 998 men and women in Gauteng. Researchers say the survey is unique in that it is the first baseline study that looks at various types of violence; the survey investigated emotional, economic, physical and sexual violence.

The MRC and Gender Links will release the full findings of the survey in March next year. They say they will encourage government to replicate the study in other regions to get a better understanding of the extent of gender-based violence in the country.

"The preliminary findings of the prevalence survey show why this is important as police statistics either fail to cover many forms of gender violence or understate the extent of the problem," the authors said.

The survey found that although one in four women in the province said they had experienced sexual violence in their lifetime, only one in 25 rapes was reported to police.

The most common form of violence against women was emotional abuse. This included being insulted, intimidated, threatened with violence or humiliated in front of others. It also included women being stopped from seeing their friends and their partners boasting about or bringing home girlfriends.

Physical violence was the second most common form of violence reported. However, most women suffered more than one form abuse from their partner.

Gender equity still a pipedream

South Africa's constitution may guarantee gender equality but that ideal has yet to trickled down to grassroots level. The study showed that more than 80% of men and women think that people should be treated the same regardless of their sex. But at the same time 58% of women and 87% of men think that a woman should obey her husband.

These views were amplified when study participants were asked about community attitudes towards men and women. For example, 80% of women and 95% of men said their community thinks a woman should obey her husband. This implies that while people's views on gender may slowly be changing, there is still strong pressure from communities for men and women to behave in certain ways.

More than a third of men also think that men should have the final say in all family matters, that a woman needs her husband's permission to do paid work, and that if a woman works, she should give her money to her husband.

Kubi Rama, deputy director of Gender Links, said that when it comes to gender, there is a mismatch between what is said in public and what is practiced privately.

"There's a general acceptance that men and women are equal but in practice we haven't moved very far. Gender roles are very static in the home," she said. "In the public space we're saying politically correct things but in our homes we go back to very patriarchal values."

Rama said South Africans needed to shift private abuse into the public sphere by making it a community issue. She said many people may not realise when hearing signs of a struggle at a neighbour's house, often it takes nothing more than a knock on the door to avert violence.

"Communities need to look after each other … Churches, temples and mosques are well placed to get involved and to promote and grasp that truly about safety and equality and the need to respect each other's rights," she said.

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Focus on Six Risk Factors could Prevent up to 80% of HIV Infections in South African Women. 29/11/10

Five factors could be addressed through prevention initiatives.


Michael Carter
29 November 2010

Addressing five modifiable risk factors could significantly reduce the number of new HIV infections among South African women, according to a study published in the online edition of AIDS and Behavior.

The researchers found that six risk factors were associated with HIV seroconversion and that five of them could be addressed through prevention initiatives.

“To have a very substantial impact on HIV prevention, a range of risk factors particularly related with unsafe sex need modifying,” comment the investigators. However, socio-economic factors, possibly related to work migration patterns, were associated with HIV seroconversion for older women.

“[The] majority of cases among women could potentially have been prevented by effective public health interventions,” write the authors.

Age was the only non-modifiable risk factor for seroconversion identified by the investigators.

HIV incidence among South African women is high and unprotected sex is the single most important risk factor for acquiring HIV in the region.

Some risk factors for HIV – such as sexual behaviour – are potentially modifiable, and researchers wanted to see the proportion of new infections that were attributable to risks that could be addressed through public health interventions.

Their study population included 2523 HIV-negative women in Durban. The women participated in three separate community-based prevention studies between 2002 and 2005.  All the women were sexually active, were regularly tested for HIV and other sexually transmitted infections, and completed questionnaires about their sexual behaviour. Information was also gathered on the women’s socio-economic circumstances, including their partnership and employment status.

The median age was 28 (range 22 to 36) and 39% were aged 24 or under. The majority – 80% - were not employed, and 58% were either single or not living with a partner. Over two-thirds (69%) of women reported at least instances of sexual intercourse in the previous seven days. In all, 88% of women said that they consistently used condoms, but 12% of women had a sexually transmitted infection at the time of entry to the study, a further 32% were diagnosed with at least one such infection during follow-up and 22% became pregnant.

A total of 211 women seroconverted for HIV, and the overall incidence rate of the infection was 7%.

One non-modifiable risk factor – younger age – was associated with seroconversion (age under 24, p < 0.001; age 25-34, p = 0.017).

All the other risks associated with new infections were related to potentially modifiable risks and included:

-     Single or not cohabiting, p < 0.001.
-     Frequency or sex (three or more acts in the previous week), p = 0.048.
-     Sexually transmitted infection at baseline, p = 0.0185.
-     Incident sexually transmitted infection during follow-up, p < 0.001.
-     Pregnancy during the study, p < 0.001.
-     Unemployed or insufficient income, p = 0.0437.

The investigators noted that reported condom use was not identified as a risk factor. However, they write, “generally, since STIs and particularly pregnancy can only occur with unprotected sex, these two risk factors can give hard evidence of inconsistent condom use.”

Information was not gathered on the number of sex partners. But the investigators believed “being single/not cohabiting combined with high frequency of sexual acts gives strong evidence of those women having multiple partners as well as possibly engaging in transactional sex.”

Next the investigators calculated the proportion of new infections that could be attributed to these potentially modifiable factors.

Overall, 82% of infections could potentially have been averted if modifiable risks were effectively addressed in public health and other social interventions.

Being single, not having a partner, and three or more sex acts a week accounted for 64% of new HIV infections. This increased to 71% when sexually transmitted infections were added.

Therefore the investigators believe that “measures aimed at reducing the frequency of unprotected sex and aggressive condom counselling with couples” could have a substantial impact of HIV incidence among women.

However, the importance of individual risk factors varied according to age.

Those related to sex were responsible for 81% of infections in aged 25 to 34. But for older women socio-economic factors had the largest impact on incidence, with not having a job/low income the reason underlying 43% of infections.

“Improving socio-economic conditions for women along with low-risk sexual behaviours may reduce…infections considerably”, comment the investigators. They call for employers to “change labour migrating patterns whereby the family unit moves with the job holder.”

They conclude that their research provides “a robust methodology for calculating quantitative epidemiology measures of disease burden that provides policy makers and health service administrators with an important tool to prioritise health service and prevention strategies.”

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Women, Girls and HIV/AIDS: A Time for Action. 21/11/10

This inequality has historically and contemporarily been reinforced by the strength of the patriarchal dispensation

The Gleaner

By Glenda Simms
21 November 2010

Informed by the research data that have emanated from the many studies, commissions and high-level debates, the United Nations has made a concerted effort to refocus on the outstanding issues of women and girls' unequal status. This inequality has historically and contemporarily been reinforced by the strength of the patriarchal dispensation that has determined the rigidity of the gendered dynamics of all the societies in the global village.

In order to address these issues, the United Nations has decided to make every effort to address continuing injustices that characterise the lives of women and girls by using the responses to the AIDS pandemic "to improve the existing situation of the world's women and girls".

To this end, the UN, through its specialised agencies (in particular to UNAIDS and UNIFEM), has put in place an "agenda for accelerated country action for women, girls, gender equality and HIV".

This agenda was formulated in 2009 when UNAIDS convened meetings of representatives of women groups including positive women's networks, men who are committed to gender equality, government policymakers, academic institutions, and the specialised UN agencies.

Much urgency

This broad-based representation of experts deliberated under the leadership of the executive director of UNAIDS.

It is with much urgency that the UN has rolled out the 2010 agenda for accelerated country action in every region of the world.

The numerous sources of information garnered from state parties' periodic reports to the committee responsible for monitoring the Convention on the Elimination of all Forms of Discrimination Against Women, the committee which monitors the Convention of the Rights of the Child, the shadow reports of non-governmental organisations and the rich body of academic research on the HIV/AIDS pandemic, all come together to reinforce the UN assessment of the status of women and girls worldwide.

This most recent agenda for accelerated country action on HIV/AIDS is based on the fact that "in most societies, women and girls face power imbalances, unequal opportunities, discrimination and violation of their human rights, including widespread violence inside and outside of the home".

It has been an established fact that these factors are directly related to the vulnerability of women and girls to the HIV infection.

In formulating the planned actions at the country level, the UN has conceptualised a holistic process which will include government, civil society, and development partners.

All of these stakeholders are being encouraged to "make national AIDS policies and programmes more responsive to the specific needs of women and girls".

The accelerated country action, which will become the launching pad for future interventions, is informed by the realisation that "nearly 30 years into the HIV pandemic, HIV programmes and policies do not sufficiently address the specific realities and needs of women and girls". In the new dispensation, those who make the decisions on programmes for intervention and prevention in the fight against HIV are directed to recognise women's inherent human rights to sexual and reproductive health care, freedom from grinding poverty, self-respect, personal dignity and body integrity, peace, justice, and access to adequate resources and freedom from all forms of violence in both the public and private spheres.

The review of the data available on the situation of Jamaican women and girls in the HIV/AIDS pandemic points to the fact that in our society, young women in the 10-to-19 age group are three times more likely to be infected than boys in this age band. This state of affairs was highlighted in the UNICEF 2006 Discussion on Excluded Children in Jamaica. This is also a focus of the generic training syllabus of the National HIV/STI2010 programme.

Troubling reality

This database, which informs the policymakers in the health, educational, and social sectors, highlights the troubling reality that very young girls become victims of HIV because they are having sexual relationships with older men. These are extremely dangerous liaisons. And the conditions that foster these must be tackled head-on if the society is to maximise the potential of the young women who need to keep healthy if they are to become agents of change in our search for prosperity and the better life.

It has been pointed out in the UNAIDS and WHO December 2004 AIDS epidemic update on HIV/AIDS in Sub-Saharan Africa and in the Caribbean region that inter-generational heterosexual sexual activities are one of the main drivers of the HIV infection in very young girls.

It has also been determined by many of the relevant agencies in the countries investigated that sexual liaisons are not necessarily consensual. Oftentimes they are the result of forced sexual activity and sexual abuse such as rape, incest, and carnal abuse.

Within this context, the agenda for accelerated country action should serve as an efficient and effective approach to deal with the continued search for answers regarding the unequal gender relations in Jamaica.

Deliberate directive

The deliberate directive to encourage the United Nations joint team on AIDS to focus on the role of civil society as a powerful change agent to move women and girls from their current disadvantaged position in the HIV/AIDS pandemic is a sound approach.

It has been long recognised that it is at the level of the community that women and girls confront their greatest challenges.

They are the nurturers, caregivers, sisters, daughters, mothers, sweethearts, wives, and grandmothers who care for the orphaned children, the sick widows, the sexually abused children, and the pregnant teenagers.

Against this background, it is reasonable to expect a vibrant, well-articulated programme of action that will put the focus on the precarious position of women and girls as they face the growing overrepresentation of very young girls as victims of the HIV/AIDS pandemic in the Jamaican society.

There is now a real opportunity for all those who purport to be committed to women's human rights to join forces with the UN country team to seize the opportunity to move from word to action.


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African Women's Decade Launched in Nairobi. 18/10/10

"Grassroots approach to gender equality and women's empowerment".

18 October 2010

Nairobi — The African Women's Decade, AWD (2010- 2020) has been launched. It has the theme "grassroots approach to gender equality and women's empowerment".

The AWD was launched at the Kenyatta international Conference Center (KICC) in Nairobi today by Kenyan President Mr. Mwai Kibaki. AU Chairperson Dr Bingu wa Mutharika spoke at the launch as did the Chairperson of the African Union Commission Dr Jean Ping.

The event attracted thousands of people, who started the day with a march from Freedom Center and proceeded to the KICC, where local and international dignitaries, conference delegates and champions of gender equality mingled together to usher in a new era in Africa's march towards equal development for men and women.

President Mwai Kibaki said the AWD should mark the beginning of an effective, focused and re energized programme of empowering women. He called for implementation of laws and policies and for equal access to education.

"We have learnt that education holds the key to unlocking obstacles to women's empowerment" the President said. He declared his government's commitment to the Nairobi Declaration, which had earlier been presented to the meeting. He also announced that in the AU spirit of empowering women, his government had ratified the African Charter on Human and People's Rights.

After declaring the official launch of the AWD, the President unveiled a plaque commemorating the launch

AU Chairperson, President wa Mutharika reminded the audience that many frameworks and commitments have been made in the past but that women have still not yet been fully emancipated. He said that the AWD should see real positive change in the lives of women, and that women should be involved in all decision making processes.

The AWD centers round ten themes i.e.; fighting poverty and promoting economic empowerment of women entrepreneurship; agriculture and food security; health, maternal mortality and HIV and AIDS; education, science and technology; environment, climate change and sustainable development; peace, security and violence against women and girls; governance and legal protection; finance and gender budgeting; women and decision making and mentoring youth.

"The ten themes were carefully thought out and linked to the thirteen critical areas of the Beijing Platform of Action, the eight Millennium Development Goals and the programme of the International Conference for Population and Development (ICPD) as well as other regional commitments", said AUC Chairperson Mr Jean Ping when he addressed the gathering at the KICC.

Institutional and governance mechanisms have already been put in place. "The Committee of 30 set up for the Decade had its first meeting during the pre summit meeting held in July this year, said Mr. Ping, adding that "the political leadership for the Decade will be provided by a ministerial committee consisting of ten ministers drawn from all the five regions of Africa".

Member states have been requested to see to the governance of the Decade by setting up national committees which will be instrumental in identifying viable grassroots projects that will be supported during the Decade through the Fund for African Women. Member states have already committed to contribute to the fund as agreed upon at the February 2010 AU Assembly meeting.

Through the fund, the AU will support women's projects around the continent.

"One project per country per theme will be financed from the newly established Fund for African Women. As a result, 53 projects will be implemented for each of the ten years, leading to 530 projects being supported during the Decade", disclosed the AUC Chairperson.

The event witnessed handing over of the mentoring torch to the younger generation and reading of the Nairobi Declaration.

The large gathering in Nairobi was also addressed by the UN Deputy Secretary General Mrs. Asha Rose Migiro, the Vice President of Zimbabwe Mrs. Joyce Mujuru, the Vice President of the Gambia Dr Isatou Njie Saidy; the Kenyan Minister of Gender, Children and Social Development Dr Naomi Shabaan. A special message from the Kenyan First Lady Mrs. Lucy Kibaki was read out to the delegates, as were messages from Tunisia, Nigeria, and Liberia

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Moulding Men you can Count On. Living with AIDS # 442. 5/8/10

Research shows that men are the main drivers of the HIV epidemic.


Khopotso Bodibe
5 August 2010

Research shows that men are the main drivers of the HIV epidemic. Men transmit HIV to women, who, in turn, can infect their babies if they fall pregnant. But this can be prevented if men become a part of the woman’s pregnancy.

Often, it is said that “the lives of women are in the hands of men”. Many women might be irked by the statement. But we all know that men are biologically responsible for women getting pregnant. Sadly, though, many men are unwilling to play their role in the pregnancy. Some even reject and abandon the woman and their unborn baby. In the age of AIDS, that behaviour has sworn many mothers-to-be to secrecy about their HIV infection, leading to babies being born with HIV.  

“A lot of women find out their HIV status when they go and do a pregnancy test or are discovered as being pregnant at the clinic. You’ll find that there was no conversation between the couple. They just assume they are negative. You will find that a lot of men (this is obviously anecdotal) have a sense of proxy-testing, where they believe if my partner’s negative, then it means I’m negative. If my child is born negative, then it means I, as a man, am negative. So, what the man will do is that he will sit there. When the woman comes back from the clinic, she will sit there; she doesn’t have the power to come back and say: ‘I’ve tested and I’m positive. Firstly, there is violence involved. Secondly, there is a possibility of being abandoned”, says Thoko Ngendane, Project Manager of “You Can Count on Me, a Pepfar-funded programme in South Africa.

You Can Count on Me aims to change men’s behaviour and to educate them that HIV transmission from parent to child, or what is called PMTCT, can be prevented.     

“We thought we need to make this project about men taking ownership. If you as a man are saying: ‘You can count on me as a man to be supportive to my woman. You can count on me as a man to protect my legacy because I’m informed, because I know better’, then that way the person is not feeling like there’s no negotiation about how they behave or how they respond to things. If you change one person per intervention, it’s an achievement. It was about the man saying that: ‘I am taking control and ownership of what it is that I need to do as a man’.”

The programme trains men to understand what HIV is, how it’s transmitted, how to prevent it in the general population, to protect babies from getting it and to help their partners along the journey of pregnancy. Model students in these workshops are then selected to train other men across the nine provinces. Approximately 10 000 men have been reached through face-to-face community meetings. Ngendane says the programme wants to deliver a key message.  

“Know your status”, she says. “We’re saying, as a man, go and do it yourself and then you can then have the power… knowing going forward… am I positive or am I negative? You have to have information in order for you to protect your children and the people that are around you”, she adds.

Social scientists and researchers and groups working with men agree that this approach of using men to influence other men to prevent the scourge of parent-to-child HIV infection is a useful strategy. Bafana Khumalo, co-director of Sonke Gender Justice Network, a group working with men and boys to change behavior, says “in a society where patriarchy still reigns supreme, men are most likely to listen to other men”.

“There’s a lot that we can do as men by speaking to each other on those issues so that, indeed, we don’t look the other way. There’s something that I can do in saying to a friend: ‘No, but that is not on’. The problem is that so long as men think we can do these things with impunity because nobody will be there to say, but ‘don’t do this’ or even give that friendly advice and say, ‘look, this is dangerous’. So long as there’s no one who is that voice, what are the options? It means this continues. It means the dysfunctions that we see in society continue unabated, and we don’t think that serves our society well. We want, therefore, to invoke that very spirit that says, ‘yes, these things happen in our presence’. We must, therefore, as men be able to hold each other accountable”, Khumalo says.

“We want to make sure that men play their role in empowering women. Men need to play a positive role. Men need not feel women empowerment is not about them because at the end of the day it is also about them. Men have a big role to play when it comes to an empowered society and we need, as men, to go out there and say: ‘We are going to play our role’,” adds Mandla Ndlovu, Communications Programme Manager for Johns Hopkins Health and Education in South Africa, which supports a number of health communications projects working with men’s health issues.   

Until recently, about 70 000 babies were born with HIV every year in South Africa. HIV is also one of the main causes of infant mortality, which has risen considerably in the last 10 years when most countries show a decline. Government’s implementation of new guidelines to protect babies and infants will considerably cut the number of babies born with HIV. However, much still depends on men learning new behaviours to empower women to access prevention services to save their babies. 

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Africa: Women, the Silent Bearers of HIV Burdens. 29/7/10

When it comes to HIV, silence suffocates the women of Sub-Saharan Africa.


Amanda Wheat
29 July 2010

When it comes to HIV, silence suffocates the women of Sub-Saharan Africa.

Most women will not learn that they are HIV positive until it comes time to seek prenatal care. They will make the sometimes seven-mile trek to the nearest clinic for pregnancy related issues and return to their villages with the burden of a deadly disease. Knowing the negative stigma associated with HIV, many refuse treatment and thus pass the virus on to their unborn child.

Nazneen Damji, Program Manager of Gender Equality for the United Nations Development Fund for Women (UNIFEM), told MediaGlobal, "When you have unequal power relations, it becomes harder for women to declare their status simply because of social norms that dictate that women are meant to be good and innocent. They just can't talk about issues related to sexuality and sex."

Over 60 percent of the adult populations in Sub-Saharan Africa with HIV are women. But because the disease is tied with a cultural connotation of amoral behavior, these women will keep their condition a secret from even their closest family members.

Women are also burdened by the stigma of being primary caregivers. For those who chose to take on the cultural risk of seeking treatment, more challenges lay ahead. Clinics are not accessible to most rural villages; women must find others to care for their children while they make the journey. Furthermore, when monetary challenges of feeding a family are already exceedingly difficult, it is unlikely there will be money left over to pay for HIV treatment.

A recent report released by UNIFEM cited lack of public knowledge as a key issue regarding gender and HIV. With a disease that is so taboo, it is no surprise that there is little discussion surrounding causes and treatments. Meanwhile, medical caregivers are not trained to address the cultural implications of the disease and rarely take these barriers into account when treating patients.

Damji said, "In hospitals in rural Nigeria for instance, there are lots of derogatory statements made toward women waiting to gain HIV treatment. You're a sex worker, you're a bad women, etc. There are very few privacy standards set to protect women from these verbal abuses."

UNIFEM set up a test protocol within one such hospital where specific rights and obligations to cultural sensitivity where built into a written code for hospital workers.

"We had great success with this protocol as a method of awareness. When people understand what is driving the epidemic, it becomes a lot easier to raise awareness on how to treat patients with confidentiality, sensitivity, and understanding," said Damji.

Experts insist it is imperative that women become a part of future policy conversations. The UNIFEM study highlighted ten key strategies for making women a part of policy. Among them was the recommendation to form democratic and transparent processes for providing support and investment into women-led HIV/ AIDS initiatives and organizations.

Damji stated, "The number one thing is to involve those who are directly affected by the epidemics. If you have a national aid strategy, you have to include women who are living with HIV. They must be sitting at the table when programs and policies are written up."

But can written policies and advanced protocols really change deep seeded cultural norms? If policies can address a widespread understanding of the unfair cultural labels placed on women with HIV, they might be able to begin breaking down the walls that prevent women from gaining knowledge and treatment.

Did you find this article beneficial? If so, please help MediaGlobal continue to provide you with development news from around the world by making a donation to support our operations.

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From Training to Transformative Leadership 22/7/10


July 22, 2010—“My mission has become making sure that the next woman who is diagnosed has a smoother transition into the HIV world than I did,” said Shannon Behning (pictured left), Executive Director of the Women’s Lighthouse Project and CEDPA alumna during a morning panel discussion at the XVIII International AIDS Conference in Vienna.

Shannon is part of a delegation brought to the conference by CEDPA through the Ford Foundation funded Advancing Women’s Leadership and Advocacy for AIDS Action Initiative. She was joined by her fellow CEDPA alumni Jemimah Atieno (pictured below) of the Kenya Teachers Service Commission and Kaythi Win (pictured below) of Population Services International-Myanmar who also shared their stories and discussed how they applied their learning to work with teachers, ex-offenders, sex workers and others.

“Opportunities like CEDPA and other leadership workshops for women are essential for growth,” said Shannon. “There must be a place to be with other leaders who are women, in a safe, supportive and educational environment.”

The women were part of the From Training to Transformative Leadership panel where they presented lessons learned from the initiative’s cutting edge leadership program that has empowered women globally to advocate for a women-centered approach to HIV and AIDS.

Though the "feminization of AIDS" is part of most government and donor lexicons, this awareness has yet to be translated into significant numbers of women in decision-making roles related to AIDS policy, funding and programs.

“I wish to advocate for increased donor funding focused on programs to build women’s capacity, especially women living with HIV, for practical reasons,” said Jemimah. “This is because any woman educated or with some economic empowerment, is sure to also educate, protect and provide for others.”

CEDPA’s Director of Capacity Building, Sue Richiedei, joined the women on the panel to give an overview of the program and the International Center for Research for Women’s HIV/ AIDS and Development Advisor, Reshma Trasi, addressed the positive outcomes of the initiative.

The initiative equipped and empowered a cadre of women from around the world with the knowledge and skills to strengthen and lead the global response to AIDS. CEDPA led a three-tiered training program that included a master trainer workshop; global programs in Africa, Asia and Latin America; and a year-long coaching program.

The initiative brought together leading global agencies including CEDPA and the International Center for Research on Women (ICRW), International Community of Women Living with HIV/AIDS (ICW), and National Minority AIDS Council (NMAC).


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Interview - Women Largely Excluded from Asia HIV Prevention Efforts - U.N. expert. 2/7/10

The main drivers behind the spread of HIV among women in the region are unprotected sex and infection by their long-term male partners

Reuters AlertNet

2 July 2010
By Thin Lei Win

Bangkok - Efforts to prevent the spread of HIV in Asia-Pacific must be urgently adapted to target a greater number of women as they are getting infected at a faster rate and pass on the virus that causes AIDS to their children, a U.N. gender expert said. Women accounted for 35 percent of new infections in Asia-Pacific in 2007, up from 18 percent in 1990, according to U.N. agency UNAIDS. "Given the volume of the population in the region, a 1 percent increase in prevalence means many, many people," UNAIDS' Asia-Pacific gender adviser Jane Wilson told AlertNet in an interview. "If China and India's national responses don't include effective engendered AIDS response, then millions of women will be needlessly infected."

The main drivers behind the spread of HIV among women in the region are unprotected sex and infection by their long-term male partners, particularly if the men are drug users who use contaminated needles, have sex with men or buy sex. Women in abusive relationships are many times more likely to get the virus from their partners, the United Nations has found.

Moreover, cultural restrictions on women's freedom of movement and their lesser standing in society in Asia-Pacific mean that they do not get tested as regularly as men and many can't afford health services at all. And HIV/AIDS is still seen as a predominantly male problem. "Between 32 to 40 percent of women are tested (for HIV) only because their husbands become sick," Wilson said. "And 75 percent don't have enough money to access (health) services."

An estimated 1.6 million women were living with HIV in Asia-Pacific in 2009. Moreover, more than 50 million are at risk of catching the virus from their high-risk partners but are largely ignored in HIV prevention programmes because they are married or in long-term relationships, according to the Independent Commission on AIDS in Asia and the Pacific. For example, the commission estimated in 2008 that up to two-thirds of male injecting drug users in the region were married or had regular female partners.

"The need (for gender-specific services) is so evident we can't ignore it anymore," Wilson said. "This is not to say we take away money from the programmes for most-at-risk populations, but to integrate the consideration for the female sexual partners."

Early this week, the United Nations launched a report to address, as it says, "the persistent gender inequalities and human rights violations that put women and girls at a greater risk and more vulnerable to HIV". "Women are disempowered to actually take control of their lives and their bodies, particularly in south Asia," Wilson said.

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UN Creates New Structure for Empowerment of Women. 2/7/10

United Nations General Assembly voted unanimously today to create a new entity to accelerate progress in meeting the needs of women and girls worldwide.

2 July 2010

For immediate release

United Nations, New York — In an historic move, the United Nations General Assembly voted unanimously today to create a new entity to accelerate progress in meeting the needs of women and girls worldwide.

The establishment of the UN Entity for Gender Equality and the Empowerment of Women — to be known as UN Women — is a result of years of negotiations between UN Member States and advocacy by the global women’s movement. It is part of the UN reform agenda, bringing together resources and mandates for greater impact.

“I am grateful to Member States for having taken this major step forward for the world’s women and girls,” said Secretary-General Ban Ki-moon in a statement welcoming the decision. “UN Women will significantly boost UN efforts to promote gender equality, expand opportunity, and tackle discrimination around the globe.”

UN Women merges and will build on the important work of four previously distinct parts of the UN system which focus exclusively on gender equality and women’s empowerment:

-Division for the Advancement of Women (DAW, established in 1946)
-United Nations Development Fund for Women (UNIFEM, established in 1976)

“I commend the leadership and staff of DAW, INSTRAW, OSAGI and UNIFEM for their commitment to the cause of gender equality; I will count on their support as we enter a new era in the UN’s work for women,” said Secretary-General Ban. “I have made gender equality and the empowerment of women one of my top priorities — from working to end the scourge of violence against women, to appointing more women to senior positions, to efforts to reduce maternal mortality rates,” he noted.

Over many decades, the UN has made significant progress in advancing gender equality, including through landmark agreements such as the Beijing Declaration and Platform for Action and the Convention on the Elimination of All Forms of Discrimination Against Women. Gender equality is not only a basic human right, but its achievement has enormous socio-economic ramifications. Empowering women fuels thriving economies, spurring productivity and growth.

Yet gender inequalities remain deeply entrenched in every society. Women in all parts of the world suffer violence and discrimination, and are under-represented in decision-making processes. High rates of maternal mortality continue to be a cause for global shame. For many years, the UN has faced serious challenges in its efforts to promote gender equality globally, including inadequate funding and no single recognized driver to direct UN activities on gender equality issues.

UN Women — which will be operational by January 2011 — has been created by the General Assembly to address such challenges. It will be a dynamic and strong champion for women and girls, providing them with a powerful voice at the global, regional and local levels. It will enhance, not replace, efforts by other parts of the UN system (such as UNICEF, UNDP, and UNFPA) that continue to have responsibility to work for gender equality and women’s empowerment in their areas of expertise.

UN Women will have two key roles: It will support inter-governmental bodies such as the Commission on the Status of Women in their formulation of policies, global standards and norms, and it will help Member States to implement these standards, standing ready to provide suitable technical and financial support to those countries that request it, as well as forging effective partnerships with civil society. It will also help the UN system to be accountable for its own commitments on gender equality, including regular monitoring of system-wide progress.

Secretary-General Ban will appoint an Under-Secretary-General to head the new body and is inviting suggestions from Member States and civil society partners. The Under-Secretary-General will be a member of all senior UN decision-making bodies and will report to the Secretary-General.

The operations of UN Women will be funded from voluntary contributions, while the regular UN budget will support its normative work. At least US$500 million — double the current combined budget of DAW, INSTRAW, OSAGI, and UNIFEM – has been recognised by Member States as the minimum investment needed for UN Women.

“UN Women will give women and girls the strong, unified voice they deserve on the world stage. I look forward to seeing this new entity up and running so that we — women and men — can move forward together in our endeavour to achieve the goals of equality, development and peace for all women and girls, everywhere,” said Deputy Secretary-General Asha-Rose Migiro.

The General Assembly resolution creating UN Women also covers broader issues related to UN system-wide coherence, laying out a new approach to the funding of UN development operations, streamlining the work of UN bodies, and improving methods of evaluating reform efforts.

Press contact: Charlotte Scaddan ,

Download this press release herein english en , Espaniol es or French  fr

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Abused Women at a Higher Risk of HIV. 18/6/10

Researchers found that addressing gender inequalities could prevent 13,9% of new HIV infections.


By Lungi Langa
18 June 2010

Women in abusive relationships have a higher risk of being infected with HIV, a South African Medical Research Council study has found.

Researchers said one in seven new HIV infections could be averted if women were not subjected to physical and sexual abuse or relationships inequalities.

In a randomised trial they studied 1 099 HIV negative women in South Africa. Women were tested once over a period of two years. Face to face interviews were conducted with women to assess exposure to gender based violence and inequality in their relationships. 

Results showed that women in relationships with low equality at the start of the study had higher incidence of HIV compared to those with more relationship power. Additionally, those who reported more than one incidence of abuse were likely to be infected compared to those with less.

Up to 51 of the 325 women relationships with less equality had higher incidence of infection compared to the73 out of 704 who reported gender equality. At least, 45 of the 253 women who reported more abuse had a higher incidence of HIV compared to the 83 of the 846 who reported less abuse.

Researchers found that addressing gender inequalities could prevent 13,9% of new HIV infections. About 11,9% of new infections could be prevented if women were not subjected to physical and sexual abuse by their partners.

“This study provides strong temporal evidence to support a causal association between intimate partner violence or relationship inequity and HIV infection. Replicating this association in the context of trials to assess effective interventions should be a priority,” the researchers said.

They urged organisations heading HIV prevention messaging for women such as the Joint Partnership for AIDS and the World Health Organisation to ensure that policies, programmes and interventions to enforce gender equality and prevent partner violence were developed and widely implemented.

“Donors and researchers must invest in efforts and resources in developing and testing new interventions,” they said.

Jay Silverman of the Harvard School of Public Health in Boston said the findings highlighted the importance of altering gender based abusive behavior and reducing sexual risk behavior  in men to prevent HIV transmission to women.


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Female Empowerment can Help Fight HIV, Researchers Say. 16/6/10

If young women in rural South Africa enjoyed true gender equality with their male partners, nearly 14% of the new HIV infections recorded between 2002 and 2006 could have been avoided

Los Angeles Times

16 June 2010
Karen Kaplan

A team of American and South African researchers has an unconventional prescription for reducing the risk of HIV among women – female empowerment.

If young women in rural South Africa enjoyed true gender equality with their male partners, nearly 14% of the new HIV infections recorded between 2002 and 2006 could have been avoided, the researchers said. In addition, if – by some miracle – all instances of physical or sexual violence by men could have been prevented, so would 12% of the new HIV cases diagnosed during that four-year period.

Those calculations come from a study published online Wednesday in the journal Lancet. The researchers crunched data from a trial designed to test the effectiveness of an HIV-prevention program called Stepping Stones.

Of the 1,099 women included in the Lancet study, 128 acquired HIV during the course of the trial. That worked out to an overall incidence rate of 6.2 new infections per 100 person-years. But the rates weren’t uniform across all groups of women.

Among those with “low relationship power equity,” there were 8.5 new cases per 100 person-years; for women in more equal relationships, there were only 5.5 new infections per 100 person-years. The researchers also found that among women who were victims of intimate partner violence more than once during the study, the infection rate was 9.6 new cases per 100 person-years; for all other women, there were 5.2 new cases per 100 person-years.

Cultures that “celebrate male strength and toughness” tend to tolerate a higher degree of male control over women, and that makes women more vulnerable to the adverse consequences of “risky sexual behavior, predatory sexual practices, and other acts of violence against women,” the researchers wrote. Therefore, health officials should be concerned not only with the availability of HIV medications but with social programs “that address violence and gender inequity in relationships.”

It may sound pie-in-the-sky, but the Office of the U.S. Global AIDS Coordinator has already earmarked $30 million for pilot programs aimed at preventing gender-based violence in Tanzania, Mozambique and the Democratic Republic of Congo, according to Jay Silverman, director of violence-prevention programs at the Harvard School of Public Health. In an editorial that accompanies the study, Silverman wrote:  “We must hope that this initial allocation will be followed by far greater investment.”


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Reducing Men's Violence and Increasing Woman's Power in Relationships Key to Preventing HIV Infection in Women. 16/6/10

Women in relationships with low equality at the start of the study had a much higher incidence of HIV compared to women with medium or high relationship power

16 June 2010

Women in South Africa with violent male partners or who are in relationships with low equality are more likely to become infected with HIV, compared to women who do not experience such behaviour. Nearly one in seven new HIV infections could be prevented if women were not subjected to physical or sexual abuse or relationship inequalities, according to an Article published Online First in The Lancet.

Despite most new HIV infections in high prevalence areas occurring in women, most HIV prevention programmes target male condom use, testing, treatment of sexually transmitted infections, male circumcision, and antiretroviral treatment. Previous studies have shown a potential link between male partner violence, relationship inequalities and increased risk of HIV infection in women. However, this evidence has not been substantiated by longitudinal research to support a causal association and this has limited the resources allocated to HIV prevention programmes and interventions that focus on gender issues.

To further examine the effects of male partner violence and power inequity in relationships on incidence of HIV infection, Rachel Jewkes from the Medical Research Council in South Africa and colleagues did a longitudinal analysis of data from a randomised trial in South Africa. They studied 1099 young African women who were HIV negative at the start of the study and who had at least one subsequent HIV test over 2 years of follow-up. Women were given face-to-face interviews to assess exposure to violence and gender equality in their relationships.

Women in relationships with low equality at the start of the study had a much higher incidence of HIV compared to women with medium or high relationship power (51 of 325 women vs 73 0f 704 women). Additionally, women who reported more than one episode of abuse at the start of the study were more likely to acquire HIV than those who experienced one or no episodes of abuse (45 of 253 women vs 83 of 846 women).

The researchers calculated that if gender inequalities were improved so that no women were in relationships with low power, 13.9% of new HIV infections could be prevented. Additionally, 11.9% of new HIV infections could be avoided if women were not subjected to more than episode of physical or sexual abuse by their partner.

The authors say: “This study provides strong temporal evidence to support a causal association between intimate partner violence or relationship inequity and HIV infection…Replicating this association in the context of trials to assess effective interventions should be a priority.”

They conclude: “Organisations driving HIV prevention agendas for women, particularly UNAIDS and WHO, need to ensure that policies, programmes, and interventions to build gender equity and prevent partner violence are developed and widely implemented. Donors and researchers must invest in efforts and resources in developing and testing new interventions.”

In a Comment, Jay Silverman from Harvard School of Public Health, Boston, USA, says that these findings highlight the importance of altering gender-based abusive behaviour as well as reducing sexual-risk behaviour in men to prevent the transmission of HIV to women.

The fastest growing sector of HIV infection in Asia and Africa is women whose main risk factor is sex with a male partner. Yet, he says, there is a lack of “effective HIV-prevention programmes for women who fall outside of ‘most at-risk populations’… the global HIV community must move to make targeting such male behaviours a central focus of prevention efforts.”

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Ghana: World Parliamentarians Pledge Action on Women/Girl's Rights. 14/6/10

Health solutions for girls and women must be complemented by a conducive political will and legislative environment for long term results and effectiveness.


By Linda Asante Agyei
14 June 2010

Accra — World Parliamentarians have pledged to mobilize support for legislative actions to ensure the health, dignity and rights of women and girls through access to reproductive and sexual health in the shortest possible time.

"We are convinced that implementing the commitment made by our governments in the major United Nations conferences and summits, will end the preventable high maternal deaths and disability that constitute the greatest moral, human rights and development challenge of our time".

This was contained in a communique issued at the Parliamentarians Forum during the close of a three-day world conference on "Women Deliver 2010," which highlighted the achievements in reducing maternal mortality, breakthroughs in reproductive technology, the role of women's health in development and the remaining obstacles to improving maternal health around the world.

The conference was attended by over 3,000 participants including national health ministers, first ladies, parliamentarians, midwives, the youth, maternal health advocates and celebrities from over 140 countries.

The parliamentarians expressed their determination by creating laws and policies with and for women and girls, giving them their fair share of funding, budget and oversight responsibilities, advocate for a women's and girls' agenda everywhere to advance MDG "5", locally, nationally, regionally and globally as well as speaking out on women and girls to create awareness and knowledge building.

The MPs explained that health solutions for girls and women must be complemented by a conducive political will and legislative environment for long term results and effectiveness.

They, therefore, expressed their commitment in demanding that key issues of women and girls' sexual and reproductive health and rights were made regular agenda items during relevant bilateral, multilateral and international meetings.

The MPs also committed themselves to generating an institutional memory by mapping legislations that governments have adhered to women and girls health and ensure their implementation, work actively towards enforcing national laws and de facto implement policies to accelerate women and girls economic, social and political rights and reduce gender inequality and gender-based violence.

They expressed concern about the funding and budget allocated to address the health needs of women and girls and called for additional 12 billion dollars a year to be invested in women and girls.

They also pledged to work in partnership with governments, civil society, the private sector and other key stakeholders to meet the 24 billion dollars needed to provide access to family planning and maternal and newborn care to all women in developing countries.

The communique called for active work in the establishment of a global funding mechanism for family planning, mothers saying "such a global funding mechanism would reduce maternal mortality by 70 per cent, avert 44 per cent of new born deaths, reduce unsafe abortions by over 70 per cent and further contribute to curb the AIDS and malaria pandemics, which has placed women and girls at greater risk.

"With the up-coming G-8 and G-20 parliamentarians" conference and the summit of leaders of industrialized nations, the MPs will take the opportunity to review the MDGs.

"Now is the time to amplify our voices to broaden the dialogue on maternal and reproductive health in the global arena and to demonstrate concrete action to achieve MDG "5", the communique added.

It called for parliamentarian's participation and inclusion in political priority setting on women and girls health at local, national, regional and global levels by establishing a clear monitoring mechanism for each MDG with a clear timeline and format.

The communique also called on health ministers to establish realistic and verifiable annual action plans for reaching individual MDG targets with a special emphasis on MDG "5", which will be presented during the UN High Level Meeting to be held in September 2010.

It said MPs would therefore take a leading role in communicating the societal, economic, political and cultural benefits of investing in women and girls to parliamentary colleagues, governments and other key decision-makers and private investors.

The world parliamentarians, the communique said, called on governments to act upon endorsed consensus on maternal, newborn and child health. GNA

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South Africa: Sports Stars Urge Men to 'Do the Right Thing'. 1/6/10

A team of top South African and international sportsmen will lend their star power to a campaign that promotes HIV prevention, and relegates violence against women and children.

1 June 2010

Johannesburg — A team of top South African and international sportsmen will lend their star power to a campaign that promotes HIV prevention, and relegates violence against women and children.

South African football players Matthew Booth and Teko Modise, rugby captain John Smit, cricket captain Graeme Smith and international football stars Ryan Giggs of Manchester United and Lionel Messi of FC Barcelona have already signed up.

These sporting talents will be Sports Ambassadors for Brothers for Life, a national campaign encouraging men to take a stand against gender-based violence and HIV.

They will promote messages on television, radio and outdoor advertising about the risks of alcohol and unprotected sex in relation to HIV, and support a national HIV counselling and testing drive launched in April by President Jacob Zuma.

Although fewer men go to be tested or seek HIV/AIDS treatment than women, they have not been the main focus of previous prevention campaigns. Now, the Sports Ambassadors will be calling on men to "yenza kahle" (do the right thing).

"When good men don't stand up to be counted, HIV and AIDS spreads," said South Africa's Deputy President, Kgalema Motlanthe. "We call upon men of all classes and races to join the fight against HIV and AIDS, occupying the front trenches in this war through their social conduct."

The campaign starts just 10 days before the FIFA World Cup kicks off and thousands of foreign football fans start arriving in South Africa. "There's going to be lots of drinking, probably quite a lot of sex, and we want to encourage people to be safe," said Dean Peacock, co-director of Sonke Gender Justice.

This is one of the 40 civil society organizations partnering with the South African National AIDS Council (SANAC), the national Department of Health, Johns Hopkins Health and Education in South Africa (JHHESA) and the UN Children's Fund (UNICEF), to promote the campaign.

"We want to use spokespeople who have the status necessary to influence the behaviour of everyone who's coming here," said Peacock. The rugby and cricket players were included to ensure that the life of the campaign extends beyond the World Cup.

Besides appearing in advertising to promote the campaign, the South African Sports Ambassadors will show up at events, bringing their high profiles to on-the-ground activities, Peacock said.

"Men have the power to make an enormous difference in their own lives, and in the lives of their children and partners," said Elhadj As Sy, UNICEF Regional Director for Eastern and Southern Africa. "The Brothers for Life Sports Ambassadors campaign shows them the way."


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Stop Violence Against Women, Priority of Eu Program. 16/03/10

In several countries, women have a lower status, because legislation, private law and family law, is still based on religion.

16 March 2010

BRUSSELS - To stop the violence against women: this is the priority issue to be dealt with in all countries on the southern shores of the Mediterranean, according to what has emerged from analysis carried out by the EuroMed Gender Equality Programme (EGEP), which has focused on the condition of women of the area in a roundtable organised in Brussels.

The 'Programme to enhance quality between men and women in the EuroMed Region', financed by the EU as part of the European Neighbourhood Policy, involves nine partner countries (Algeria, Egypt, Israel, Jordan, Lebanon, Morocco, the Palestinian Territories, Syria and Tunisia). "There are national strategies," explains Judith Neisse, team leader of EGEP, "like the case of Morocco, where studies have already been carried out, or else countries where studies are underway such as in Tunisia.

Several countries have laws on sexual harassment in its penal code, for example Israel and Morocco. The EGEP programme will specifically help the conducting of a national study in Jordan and in Lebanon, because they are the two countries that have still not carried it out."

There are states that have inserted violence against women into their penal code and not into private law: "for example," Neisse continues, "Jordan and Morocco: this is already a step in the direction of the criminalisation of violence, independently of who commits it. Family law in fact often does not allow the charging of husbands who commit violent acts: it is said that they are family disputes, tensions, there is a certain trivialisation of the phenomenon."

Another key issue for Mediterranean countries is the role of women in the decision-making process, in public and in private. "We talk about the presence of women," explains Neisse, "in the economic and political world, but also of their role in the family.

In several countries, women have a lower status, because legislation, private law and family law, is still based on religion. In several cases, the approach is archaic, especially for marriage or divorce. Also in the case of Israel, due to the attachment to the law of Moses' time."

To make family law lay is one of the aims to be reached for women in the Mediterranean region. According to Neisse, a case where it would be absolutely necessary is Lebanon "with its multiconfessionalism, where ever religious community has its rules, from Orthodox Christians to Shia and Sunni Muslim, with action differing from one community to the other. A solution would be to have a single family code, based on non-religious considerations."

Several countries "have begun to work on the better interpretation of the Islamic law," states Neisse, "with respect to the international conventions, such as Morocco and Algeria." Whilst Tunisia boasts women's status and a family code that is very advanced.

The idea of EGEP is to create subgroups of EU Partner Countries at regional level in order to work on training at sub-regional level. "After gathering data and the priorities," Neisse concluded, "for the final phase we have a series of regional seminars to work with other figures involved. We will identify a series of priorities of groups of countries, on the basis of which we will carry out training, between the second half of 2010 and the first half of 2011." (ANSAmed).

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International Women's Day: EU Action Plan puts Equality and Empowerment High on the Development Agenda. 8/3/10

The goal of promoting gender equality and women's empowerment (MDG 3) is lagging behind in many countries.

8 March 2010

Sommaire: 8 March 2010, Brussels - Today, on the occasion of International Women's Day and of the 15 th anniversary of the Beijing Declaration, the European Commission services have outlined an EU Action Plan on Gender Equality and Women's Empowerment in Development for the period 2010-2015. This Action Plan aims to accelerate the achievement of the Millennium Development Goals (MDGs), in particular on gender equality and maternal health, as well as to contribute to attaining other international development goals related to gender equality. The Action Plan suggests actions in areas, such as the organisation of regular political meetings to assess progress on the issue, the setting up of gender databases and analysis and a stronger involvement of civil society.

"Improving women's daily lives in the world will be one of my priorities", stated Andris Piebalgs, European Commissioner for Development. "The EU is the world's biggest donor, so we have to show leadership to put gender equality high on the political agenda. This is all the more urgent since the two Millennium Development Goals dedicated to women and maternal health are lagging behind the most. We have to enhance our ability to assist countries to implement their gender commitments and to support the efforts women's groups and networks in their fight for greater equality,"

15 years after the Beijing Declaration and on the eve of the 10 th anniversary of the Millennium Declaration, the objective of gender equality in partner countries is still a distant prospect. The goal of promoting gender equality and women's empowerment (MDG 3) is lagging behind in many countries, although the world continues to see progress on gender parity in education. The same can be said for the participation of women in politics, which while increasing in some regions, is largely absent or stagnant in others. On the improvement of maternal health (MDG 5), a more pessimistic picture emerges as this goal has made the least progress out of all MDGs. Every year half a million women and girls die from pregnancy-related causes. Acts of gender-based violence continue to be widespread worldwide, particularly against women and girls.

In light of this situation, and building on the current policy framework set in the 2007 Communication on Gender Equality and related Council Conclusions, the new EU Gender Action Plan calls for a three-fold approach that combines political and policy dialogue, gender mainstreaming, and specific actions for specific cases.

It also aims to reinforce EU coordination regarding gender equality policies and actions in development in the interest of having more of an impact on the ground.

The EU is constantly promoting women's rights in its cooperation with governments and civil society, both in its political dialogues as well as in its concrete cooperation on the ground. The scope of its action is vast including a system of micro-credits for women in Morocco, support of rape victims in Botswana, empowerment of women in conflict zones in the Middle East.

International drawing competition: in order to raise awareness with a concrete action targeting a younger public in the developing world, the European Commission is, for the fourth year in a row, organising an international drawing competition on gender equality. Eight to ten year old children from Africa, Asia, Caribbean, the Pacific, Latin America, Mediterranean, the Middle East and other European Countries, including the EU's Eastern Neighbours are invited to show their vision of gender equality. This year's theme proposes to reflect on how girls and boys, women and men, together can make the world a better place. The winners in each region will be awarded a prize of €1,000 each, which can be used to buy books, computers or other education materials. Since the first edition of the competition in 2007, almost 60,000 children all over the world have contributed to the dialogue on gender equality at home and at school, while national and local authorities, as well as civil society, have often been closely involved.

More info:

EU Action Plan on Gender Equality and Women's Empowerment in Development:

International Competition on Gender Equality

Europe for Women

Success stories of EU-funded projects:

Women Against Rape, Botswana

Campaign for the eradication of violence against women and human trafficking in the state of Tlaxcala, Mexico

Regional initiative for the equality of women in employment in Argentina, Colombia, Paraguay and Peru

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Intimate Partner Violence and its Links to HIV/AIDS. 3/10

Women and girls are particularly vulnerable to contracting HIV infections

Afro AIDS Info

by Marike Kotzé
1 March 2010

Women and girls are particularly vulnerable to contracting HIV infections1. One of the reasons for this is the world-wide problem of gender-based violence, perpetrated against women and girls, more often than not by people who are known to them2.

A recent study in the United States has also found a strong correspondence specifically between the occurrence of Intimate Partner Violence (IPV) and HIV infection3, while studies from Kenya, South Africa, and Tanzania reported that women who were infected with HIV had a higher probability of reporting IPV than those who were uninfected4. In Rwanda, women who have suffered from any kind of abuse in their marriages are up to 3.46 times as likely to be sero-positive compared to their counterparts who have not experienced any abuse5.

What is Intimate Partner Violence (IPV)?
Violence committed by a woman’s intimate partner includes physical violence, sexual violence as well as psychological violence1.

Physical violence constitutes any physical attack such as a slap, a punch, a kick, physical attack with a weapon as well as murder, while sexual violence consists of rape, intimidation and threats, harassment, unwanted touching and making someone take part in pornography. A women or girl is considered to be psychologically abused when she is humiliated, intimidated, isolated from her friends and family and prevented from earning a living, when her earnings are taken away by the abuser, or when she is denied the necessary resources.

Intimate Partner Violence (IPV) is the type of violence against women that causes the most deaths and is also the most widespread form of gender-based violence6.

Prevalence of IPV
Although most people would assume that something like rape is committed by strangers, more often than not, women and girls are forced into sex by people that are familiar to them such as their intimate partners, members of their family and other people they know such as school teachers and authority figures in their lives1,2.

The exact numbers from different studies vary, but the upper limits from extensive studies conducted in countries across the globe show that more than 50% of women have experienced abuse by their intimate partners1,6,7.

The close connection between IPV and HIV
IPV is acknowledged as a significant source for the deterioration of a woman’s capacity to influence her reproductive and sexual health6. There are both direct and indirect risks of HIV to women who are faced with sexual violence2,3 and the problem is exacerbated when the perpetrator is an intimate partner.

The direct risks include perpetrators who are HIV-positive, exposing them directly to the virus during an act of rape2,3.

Indirect risks are linked to the behaviour of the perpetrators of violence as men who are abusive towards their wives and who are often more likely to exhibit other unsafe sexual practices such as having multiple partners and refusal to use a condom5.

If a girl experiences sexual violence, she is more likely to exhibit unsafe sexual behaviour and where people experience sexual violence in intimate relationships, their power to negotiate safe sex is often diminished2,3,6.

Women who are living with HIV often become victims of violence and abuse2. The fear of violence will prevent many women from seeking information and treatment offered by HIV/AIDS prevention campaigns2. This same fear also prevents women from disclosing their positive status to their partners1.

What are the opportunities to address IPV in HIV preventative programmes?
Health professionals as well as policy makers need to be made aware of the close linkage between IPV and HIV so that legislature can be adapted accordingly3.

The links between IPV and HIV require further investigation in order to find the best method of attending to both issues7. Understanding the factors that allow women to demand protected sex will allow policy makers and health professionals to use these facts to decrease the number of HIV infections9.

Apart from the health burdens imposed by IPV, there are also high financial costs associated with IPV8. Domestic violence can be addressed as part of HIV preventative strategies as well as stand-alone initiatives aimed at addressing the deeper causes of gender-based violence such as the need of men to prove dominance and power over women2.

Programmes that pay more attention to gender attitudes and sexual norms related to masculinity and femininity might help to address some of the factors that lead to IPV. Examples of such programmes which have already been implemented include Men as Partners (MAP) and the Stepping Stones programmes1.

Women who test positive for HIV should be screened for IPV and receive necessary counselling and treatment1,3.

Although most studies have shown contraception use to decline among women who have experienced IPV, a recent study conducted in sub-Saharan Africa showed an increase in female controlled contraceptives among the victims of IPV. This suggests that the wider distribution of female controlled contraceptives may prove an effective route of contraception, although it does not protect them from sexually transmitted infections and HIV. Thus, it leads to the conclusion that only interventions directed at both males and females will be effective 4.

Programmes aimed at targeting IPV should address the underlying factors that cause such violence, including: gender inequality, multiple partners, alcohol abuse and poverty7.

A study conducted by the University of Botswana in 2005 concluded that a woman’s dependence and feeling of powerlessness reduces her capacity to negotiate condom use. This study also found that men with multiple partners were more prone to refusal to use condoms9.

Communication about HIV/AIDS between intimate partners should be strongly encouraged by all HIV prevention initiatives9.


Violence Against Women and HIV/AIDS: Critical Intersections - Intimate Partner Violence and HIV/AIDS.pdf. here
Sexual Violence and HIV: Understanding the Linkages.pdf here
Sareen, J., Pagura, J. & Grant, B. Is intimate partner violence associated with HIV infection among women in the United States? General Hospital Psychiatry 31, 274-278
Alio, A.P., Daley, E.M., Nana, P.N., Duan, J. & Salihu, H.M. Intimate partner violence and contraception use among women in Sub-Saharan Africa. International Journal of Gynecology & Obstetrics 107, 35-38 (2009).
Annie M. Dude Spousal Intimate Partner Violence is Associated with HIV and Other STIs Among Married Rwandan Women. AIDS and Behavior  (2009).
Krishnan, S. et al. Poverty, Gender Inequities, and Women’s Risk of Human Immunodeficiency Virus/AIDS. Ann N Y Acad Sci. 1136, 101-110 (2008).
Karamagi et al Intimate partner violence against women in eastern Uganda: implications for HIV prevention. BMC Public Health 6,  (2006).
Tabitha T Langen Gender power imbalance on women's capacity to negotiate self-protection against HIV/AIDS in Botswana and South Africa. African Health Sciences 5,  (2005).
Intimate Partner Violence-High Cost to Households and Communities.pdf. here

Reviewed by: Hendra van Zyl


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New UN Campaign Targets HIV Prevention for Women. 3/3/10

The proportion of women infected with HIV has risen in many regions of the world over the past 10 years

3 March 2010

The United Nations launched a global campaign Tuesday to prevent girls and women from contracting HIV, now the leading cause of death and disease among women worldwide between the reproductive ages of 15 and 49.

The U.N. AIDS agency and Scottish singer and AIDS activist Annie Lennox unveiled a five-year action plan amid a two-week meeting to review a 1994 platform to achieve equality for women. The platform was adopted by 189 countries at a historic conference in Beijing and included a call for increased action to prevent HIV in women as well as treat and care for them.

The U.N. Millennium Development goals, adopted in 2000, include halting and reversing the AIDS pandemic by 2015.

But Michel Sidibe, the executive director of UNAIDS, said the agency's latest report in December showed the proportion of women infected with HIV has risen in many regions of the world over the past 10 years.

According to UNAIDS, HIV is the leading cause of death and disease worldwide among women of child-bearing age from 15-49. In sub-Saharan Africa, 60 percent of people living with HIV are women, and in southern Africa the prevalence of HIV among women aged 15-24 is on average about three times higher than young men of the same age, UNAIDS said.

Lennox said a "broad movement for change" is needed.

"I see this agenda for action as a great opportunity to bring the realities faced by many women and girls to the forefront and to call attention to the injustices faced by many women and girls, placing them at a bigger risk of HIV," she said.

Nearly 30 years into the HIV epidemic, Sidibe said, growing inequality between women and men and human rights violations against women including "brutal rapes" and trafficking for prostitution are putting women and girls at greater risk of HIV infections.

He told a news conference that 400,000 babies are born every year with HIV in Africa and 30 percent will die before their first birthday without medicine, "but it also means 400,000 women have not been checked for HIV" and had no treatment "to at least avoid the transmission from mother or child."

"What we are trying to do is create a new movement, to mobilize the world around a new urgency - urgency which is about stopping violence against women ... an urgency which will call for a new mobilization of leaders in order to reduce the number of new infections among girls" and will target more services to women, Sidibe said.

The Agenda for Action launched Tuesday calls for the U.N., governments and voluntary organizations to work together to combat violence against women, analyze and address the factors that prevent women and girls from protecting themselves against HIV, and scale up engagement with men's and boys' organizations to support the rights of women and girls.

Suksma Ratri, who has HIV, and is a member of Indonesia's Positive Women's Network, said she believes the agenda will help countries strengthen services for women and girls - including those with the virus that causes AIDS.

If the agenda is implemented by every country, she said, "gender inequality between men and women will slowly vanish" and women will be empowered, even HIV positive women.

Sidibe said he believes the plan will work because it was not developed just by the U.N. but by governments and voluntary groups and has a timeline with targets.

For the first time, he said, countries will be reporting back and there will be "a scorecard which can really show what type of progress has been made."


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UN: HIV/AIDS Leading Cause of Death and Disease Among Younger Women. 2/3/10

The five-year plan hopes to eliminate gender inequalities in HIV-prevention and treatment


By Margeret Besheer
2 March 2010

The United Nations AIDS agency says in many societies young women and girls face discrimination and gender inequalities that can make them more vulnerable to HIV infection. The agency launched a new initiative Tuesday to reverse that trend and put women at the center of national and local AIDS response.

Suksma Ratri's story is like that of many other women around the world.

Separated from her physically abusive husband she found out that he was HIV-positive. She immediately got herself and their young daughter tested at a clinic in her native Indonesia. She tested positive, her daughter did not.

But it is Suksma's response to the news that is different from many other HIV-positive women. She told her closest friends and her employer and has been open about her HIV status ever since.

"Actually, I'm enjoying myself being open, because every time I say, 'yes, I'm HIV-positive,' people are like, 'oh my god, you're no different.' I say, 'yes, I'm no different. It's just I have the virus and you don't, and that's the only difference between us,'" said Suksma Ratri.

Suksma's story reflects a bigger trend in global HIV/AIDS infection rates. According to UNAIDS, HIV is the leading cause of death and disease among women ages 15-49.

Across the globe, women make up fully half of the epidemic.

And in sub-Saharan Africa, where some of the highest HIV rates are, 60 percent of the people living with HIV are women.

UNAIDS Executive Director Michel Sidibé warned that this has serious consequences for the health and mortality, not just of women, but their children as well.

"400,000 babies are born every year in Africa - 400,000 babies with HIV/AIDS," said Michel Sidibé. "It means that amongst those babies which are born, we will have almost 30 percent of those babies will die before their first anniversary [birthday] if they do not have access to medicine."

Sidibé says this is a symptom of a larger problem.

"Worse than that one, it means that 400,000 women, mothers, have not been checked, have not been having access to services, have not been able to at least avoid transmission from mother to child," said Sidibé. "But also they will be at risk to not live with us for years to come."

Sidibé says the new UNAIDS initiative aims to give women and girls the power to prevent HIV infection, by giving them the information and skills to negotiate when and how they have sex; to protect their human rights; and ensure their access to prevention, care and treatment.

The five-year plan hopes to eliminate gender inequalities in HIV-prevention and treatment by getting governments, civil society and development groups involved in putting women and girls at the center of their AIDS response.

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Gender News 2009 and Earlier

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The Silence of the Innocents. 30/12/09

This year’s 16 Days of Activism for No Violence Against Women and Children were set in a context where South Africans, especially African communities, are scrambling to cope with the breakdown of their families and communities.

History Matters

Nomboniso Gasa
30 December 2009

It is just more than a month since the first day of the 16 Days of Activism for No Violence Against Women and Children campaign.
The critical aspect of this campaign is to promote behavioural change to ensure that our society lives the reality of 365 days of no violence.

During the 16 days, two major days are marked across the globe: World Aids Day and the International Day of Persons with Disabilities.

Regrettably, on both days, the government was not able to draw the links – in many of our communities, we know of many women who are sexually abused by able-bodied and often men of position, because of sight challenges, mental-related disability, and so on.
The women and girls continue to be silent victims. And when they dare to speak, it is like spitting in the wind.

In the past 10 years in particular, South Africa has shown a disturbing and dangerous tendency to distort cultural norms, and the re-invention of “African culture” is often expressed in singular and static fashion as an explanation for all manner of practices and decisions.

In many public discussions on this thing called “African culture”, the dominant voices have been from men, especially black men.
There’s nothing wrong with that, it is a free country, and it is about time, too, that people engaged on matters that affect and concern them – be these philosophical, cultural or religious, or issues of social practice.
This is not unexpected from a society that has emerged from a system that sought to destroy the very core of who we are as a people, including white people.

Systems of racial supremacy destroy not only those who are oppressed, but generations who come from the oppressor and privileged sectors.

Admittedly, the nature of harm, trauma and psychological wounding takes different forms.

Literature on race subjugation has eloquently shown the critical necessity of buy-in and internalisation of racial supremacy by the subjugated subject.

James Baldwin said that when the oppressed recognised oppression and articulated it is as such, the first and most powerful step towards self-liberation had been taken.

Critical as that step is, we all know from our respective positions and experiences that it is merely a beginning and much work needs to be done, consistently and at deeper levels.

As a feminist, my own location is important.
Therefore, let me state that I come to the historical and contemporary subject of subjugation, oppression and inequality as a married heterosexual African woman in her 40s who grew up in poverty in an apartheid Bantustan – the subaltern of this country.
The place of origin and its multiple nuances, and the texture of my childhood, affected my life in different and fundamental ways. Thus at all times I am conscious of the interconnectedness of race, class, rurality, sexuality, gender, ethnic hierarchies and contradictions among many others.

As a girl, I had the privilege of jumping trees, punching and being punched by girls and boys in the playground.
When the fists failed, my friend who knew the art of stick-fighting taught me its delicate balance and how to land a killer hit, ever so lightly.

On the playground, I learnt the dignity that comes with humility and the delicate ways in which the victorious have to handle themselves.

I was not even 10 when I learnt that to beat your opponent to the ground or rub someone’s nose into dirt is undignified – Myeke (let him be), friends would whisper when they saw the other person faltering. It all had to be quick and discreet.
We swam with boys in the river, exposing ourselves to water-borne diseases of which we knew nothing. We caught little worms – inkwili – and coached them to bite our nipples in the never-ending quest for womanhood – breasts not only being evidence but a crown of grown-up status.

The childhood I have just outlined was not idyllic. We did witness more than a fair amount of violence between adults.
I was seven when I first heard the word ukuqhomfa (to abort) whispered as an explanation for someone’s sudden death.
Often, mothers were blamed and beaten when their daughters were pregnant, made to take responsibility for isehlo – the shameful fall of the daughter. In my safe place, between the sofa and the curtains, I heard terrible and terrifying stories and once saw a woman telling my mother of what had happened to her.

Speaking through swollen lips, she said, pointing to the lower region of her body: “Yes, he wants this and uyithatha ngolunya (takes it forcefully).”

I find myself revisiting that childhood, not because of nostalgia, but to understand the complexity of the world I inhabited as a girl and that which is inhabited by many girls of the same age today – not necessarily better, but different.
This year’s 16 Days of Activism for No Violence Against Women and Children were set in a context where South Africans, especially African communities, are scrambling to cope with the breakdown of their families and communities.
Regrettably, the methods, approaches and strategies deployed lead to even greater destruction.
I followed and took part in the campaign in the company of mental images of young girls of Cwija village in the Mpondo area in the Eastern Cape, which I visited early this year.

I see their small waists, not fully formed, with scarves that are worn by married women going twice around their bodies. These girls, who look like they are playing house, are part of a group of young women who are given away in the practice of ukuthwala (forcing of the child into marriage, often with an older person, or forcing parents into agreeing to the forced marriage – in some cases, it may count as statutory rape).

As imbizo was in progress, these girls watched – some with vacant eyes, some with a sadness that cut deep into the heart. Others had expressions I could not read. Their faces and bodies – many were already pregnant by the time we went there – are always in my mind’s eye.

Whose children are these, I wondered as I heard elderly Mpondo men refer to the girls as whores who will bear multiple children to get government grants.

They blamed everybody.

The government, for introducing child grants and for its laws, including those concerning child abuse. The church – it was not clear for what exactly, but the institution came under vicious attack.
One old man replied to my question with indlal’ibomvu mntra’mbhem (the wolf is at the child of my brother).
Whose children are these whose bodies belong to all to use in any way they want?
Two weeks before the 16 days campaign began, a weekend paper carried a leading story about the introduction of compulsory virginity testing in the Qunu schools.

The paper reported that HIV/Aids statistics were alarmingly high, that drastic steps had to be taken.
The principal wrote to parents informing them that because of this, compulsory virginity testing would be introduced.
Not a single government department made a statement about the illegality of compulsory testing – or the futility of the exercise.
Already, we know from that article, that many parents have been cowed by the voice of authority in the village. Many parents, it was reported, take their children as far as Butterworth to have private tests done.

It would be interesting to see whether virginity testing in this context is going to bring down the numbers at all.
More likely, it will simply contribute to the stigma and feminisation of the disease.
Even during the 16 days campaign, the violations of the girl are left out of the picture.
How can these violations be interrogated? They are committed in the name of culture and that makes them sacrosanct.
(If HIV infection is going to be controlled by testing girls’ virginity, with whom do they have sex? Who tests the man, often older sugar daddies, who manipulate the girls into having sex?)

Those who are familiar with human physiology tend to doubt the accuracy of these virginity tests on the grounds that the hymen breaks in so many contexts – sport, boyish acts such as jumping trees, perhaps – not only during sex.
That is not to even think of whether the “traditional testers” actually pick up anything.
Visiting Cwija last year, we had a conversation with a hilarious girl who is part of “izintombi zenciyo” – inciyo is the bead apron worn by “untouched” girls.

The giggling girl told us that the whole thing was a joke – yindlalo. She gave me rather shocking information about cover-ups, tricks of the trade and so on.

When I asked her whether she did not believe in virginity she replied: “I am in this group because of the pressure and we are told there are opportunities, scholarships and so on. And no, I have not been with a boy, but even if I were who would know? Her?” She pointed her head towards the leader. “She has no clue. What about her own daughters?”

Looking at Cwija alone, we can already tell that in fewer than 10 years South Africa will have serious problems.
Like in so many countries, especially parts of east Africa and Sahelian west Africa, these girls, after multiple pregnancies, will be roaming the streets, social outcasts because of the unpleasant nature of their cervical complications.
We can tell now that many children are trapped between staying in the forced marriages, bearing children and getting HIV along the way, or running away.

But few can go back home – they are damaged goods.
Some of us are still grappling with the unintended consequences of promoting male circumcision as a preventative intervention, wondering what this means for the girl who may be involved with a boy who has just been circumcised.
I am still finding words to articulate how this so-called preventative intervention is going to skew the numbers and expose girls.
Even the World Health Organisation acknowledges that the benefits of circumcision in prevention are minimal.
The truth is more sinister than we dare imagine.

The silence on these issues during this year’s 16 Days of Activism for No Violence Against Women and Children spoke powerfully, even more loudly than the denials and justifications.
The violence threatens to overwhelm us, that much is true.
And yet, it is the silence of the “innocent” that wounds deeply. The impact will be felt for generations to come.

Whose children are these?

Wole Soyinka answered this question in his poem The Children of This Land

“…These are the offspring of the dispossessed,
The hope and land deprived. Contempt replaces
Filial bonds. ….
A gleam

Invades their dead eyes briefly, lacerates the air
But with one sole demand:
Who sold our youth?”

• Nomboniso Gasa is contributing editor to The Star and the editor of Women in South African History (HSRC Press, 2007). She is a gender policy, political and cultural analyst.

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Launch of ‘10 Reasons Why Criminalization of HIV Exposure or Transmission Harms Women’. 1/12/09

The legislative trend toward criminalizing HIV exposure or transmission undermines public health and women’s human rights.’
Tyler Crone, Co-Founder and Coordinating Director of the ATHENA Network.
Athena Network

Responding to current trends towards criminalizing HIV transmission and exposure, human rights and AIDS activists are raising concerns about the implications of these laws, especially for women.

Calling for rights-based approaches in the response to HIV and AIDS, the publication ‘10 Reasons Why Criminalization of HIV Exposure or Transmission Harms Women clearly illustrates how criminalizing HIV exposure or transmission – far from providing justice for women – endangers and further oppresses women. This document, with 21 original endorsing organizations from around the world, affirms the protection and advancement of women’s rights as key for effective HIV and AIDS responses, and opposes laws that criminalize HIV exposure or transmission.

Women continue to be disproportionately infected and affected by HIV and AIDS. More than half of all people living with HIV are women, and women continue to be at high risk of HIV infection and of related rights abuses. Thus, any response to HIV and AIDS should take into account the effects that the pandemic, and the responses to it, have upon women and women’s vulnerability to HIV infection. Given the gendered societal context in which laws that criminalize HIV transmission or exposure will be applied and implemented, it is more likely to be women who will be prosecuted and feel the consequences of such legislation.

Recently, more than 20 countries in sub-Saharan Africa alone have passed legislation with clauses ranging from mandatory HIV testing and disclosure, to criminalizing exposure or transmission of HIV. Similar laws have been enacted, or are pending, in parts of Asia, Latin America, and the Caribbean. However, as argued by Johanna Kehler, Director of the AIDS Legal Network, South Africa:
‘What we need are interventions that address women’s HIV risks; not legislation that increases women’s vulnerabilities to HIV transmission and to rights abuses. We need laws that protect women’s rights and not tools that criminalize women. We need to focus on removing barriers to effective HIV responses, not on creating additional obstacles for women’s access to available HIV prevention, treatment, care, and support. Criminalizing HIV transmission is indeed ‘bad policy’; as it threatens human rights and harms women.’

While a call to apply criminal law to HIV exposure and transmission is often driven by a well intentioned wish to protect women, it does nothing to address the gender-based violence or the deep economic, social, and political inequalities that are at the root of women’s and girls’ disproportionate vulnerability to HIV.

‘Laws that criminalize HIV exposure and transmission will further victimize and oppress women; as these laws will aggravate the risk of violence and abuse, reinforce gendered inequalities, promote fear and stigma, and ultimately increase women’s risks to HIV and HIV-related rights abuses’ stated Michaela Clayton, Director of the AIDS and Rights Alliance for Southern Africa.

Endorse 10 Reasons Why Criminalization of HIV Exposure or Transmission Harms Women’ by sending an email with your name, country of residence, and affiliated institution to

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Will the Real South African Man Please Stand Up. 12/12/09

Have we forgotten the lessons we were taught by our fathers? asks John Kani

Times Live

By John Kani
12 December 2010

I was born into a very big family: my grandfather, Jacob, had three wives, which meant I had a thousand uncles, aunts, nephews, nieces, brothers and sisters.

My grandfather ran the family like the head of the Mafia. There were strict rules about behaviour and responsibility. He truly believed that it was the responsibility of the stronger ones in the family to protect and defend the weaker, often the womenfolk.

I remember when I was young, I came home and reported that my brother was fighting with another young man in our township. My father asked, "What did you do?" I was so embarrassed that the only word that would come out of my mouth was "Nothing."

This question has stayed with me the rest of my life - the fear of doing nothing when something wrong was happening. We were always taught to love, protect and defend our sisters, to respect and honour our mothers, aunts and grandmothers. This seemed to be the natural way of how a young man should or must behave.

Later in my life came the time for initiation to become a man. As young Xhosa tribesmen, we would spend six to 12 weeks in the woods near the mountains, after being circumcised, to become men. Our carers, amakhankatha, taught us all the lessons of life- of being a man, of being a father, of being a member of the community and of ultimately being a leader. We were told that a woman was a mother of the nation, irrespective of how young or old she was. We were taught that it was our responsibility to defend and protect our families and our communities.

I became a man, returned to the community, married and had children - four sons and three daughters. Having observed how my own father instilled in us the value of the family as the basis of any community, I knew that a strong family was a strong community. One of the things that we knew, as men, we could not do, irrespective of the circumstances, was raise our hand to a woman. I remember what my father once said to me: "Induku yomfazi ngumnqwazi." This simply means, "The stick you want to use to beat your wife is actually your hat" - meaning that whenever a conflict arises between a man and his wife, the man must take his hat and go for a walk.

This stayed with me all my life. I have passed it on to my sons, my friends and anyone I come into contact with. Some men often say to me, "But you know that women are always causing trouble, challenging your manhood," and I always say that being a man is never challenged by anything that anyone can say to you.

You are a man.

South Africa before democracy had rules, structures and modes of conduct that could never be flouted by any man who was in the struggle for liberation. As we committed ourselves and our lives to the liberation of our country, we stood in those trenches and on the front lines of the liberation war with our women. It amazes me post-1994 that suddenly the women who were our comrades and compatriots are now suddenly the victims of the same men who fought with them for liberation.

These days I am afraid to pick up a newspaper, listen to the radio or watch TV to hear how many women and children have been abused. I can't understand how the lessons we learnt as young men could suddenly have no meaning or impact in the manner in which we treat women and children.

Someone said over the radio, "The most frightening thing today in South Africa is being a woman." Wow! Where are the men when women make such a call?

To me, this is the same call our leaders made to mobilise us as young men to fight for freedom. This is the same call religious leaders make every Sunday to our communities to strive for peaceful co-existence. This is the same call our teachers make to us in the fight against ignorance. What is it going to take for us men to heed this call?

I was in a taxi in Toronto, Canada. The taxi driver asked whether I was from Africa. I was nervous to say South Africa because I knew exactly what the next question was going to be: "Is it true that African men believe that when they rape a child, they can pass on the HIV virus to the child to cleanse themselves and be cured of the disease?"

Why are there so many men in South Africa who rape women? These are questions that torture my soul. If we can call an indaba of all the learned men of our country to deal with the impact of the recession on our economy, when will we call a similar indaba to deal with this scourge?

So will the real South African man stand up? We need to stand up and be counted so that it can be clear to ourselves, our communities and the whole world that there are more of us, the good men, the good South African men, than the few who give us a bad name.

Today the worth of the average South African man is being eclipsed by the men who are not worthy of being called "men". The real South African man is a man of honour, decency and self-respect. He respects himself and he respects women - the mothers, wives, sisters and daughters of this great nation. He respects the nurturing they do, and what they have done and continue to do to build this nation. A true South African man would never lift a hand to a woman, would never hurt or maim a woman, let alone a girl child. This would go against the essential grain of his being; this would demean him as a man.

Therefore, a great injustice is being perpetrated against the real South African man by those "men" who abuse women and children.

Sadly, as a result of the huge increase in domestic and gender violence in South Africa today, all South African men are being tarred by the same brush, by the perception that African men feel it is their right to abuse and maim.

The cry of all real men is: "Why?" Why do some "men" - a very small proportion of our male society - feel that they can take their anger, their lack of self-esteem, their lack of self-respect out on women and children?

So, in defence of our manhood, in defence of our culture, in defence of all self-respecting and honourable men in this great country of ours, will the real South African man please stand up?

Kani is an internationally renowned actor and director and an Ambassador for Brothers for Life, a nationwide movement that aims to mobilise men to speak out and take action around the true values that define being a man


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Young Women More Vulnerable, Says AIDS Guru. 2/12/09

Tools currently used to combat the spread were "mismatched" against the group showing the highest incidence rate - young women.


 By Latoya Newman

Women in their teens and twenties were bearing the greatest burden of the HIV/Aids pandemic and South Africa's tools to fight the spread of the disease were not doing the job, a health conference in Durban heard on Wednesday.

HIV/Aids expert Salim Abdool Karim said at the fifth Public Health Association of South Africa conference on Wednesday that the disease continued to spread unabated in the country and that it was not the "mythical" disease of poverty.

Karim said the global pandemic showed that sub-Saharan Africa bore the greatest burden of the disease in the world. South Africa had the highest single burden and KwaZulu-Natal was worst affected.

He said the rapid spread was a "complex, multi-layered problem", which required an appreciation of the underlying dynamics.

The main point was that the tools currently used to combat the spread were "mismatched" against the group showing the highest incidence rate - young women.

"The number of new infections presenting in young women is part and parcel of the spread of infection. In the last seven years, teenage girls have come in to pre-natal clinics already showing high prevalence. It's scary when you see two out of 10 come in already having HIV," said Karim.

He said a study conducted in KwaZulu-Natal showed that 30.2 percent of rural women, 59.3 percent of urban women and 59.4 percent of sex workers (from truck stops in the study) were infected. Research showed that close to one in five women would become infected in the coming year.

Karim said the abstinence, behaviour (be faithful), condoms, counselling and testing, and circumcision strategy was not effective in this group. "You have to consider the underlying socio-economic variables. It is difficult to promote abstinence with variables like sex influenced by money, prestige, security and the comfort of having an older partner, for which the majority of young girls were opting. In many incidents, girls are faithful, but often their partners are infected."

Karim said a young girl would have difficulty getting an older man to wear a condom and circumcision only protected men. "So if you look at the toolbox, we do not really have the tools to translate into risk reduction in this group," said Karim.

He dismissed the notion that HIV/Aids was a disease of poverty, saying a study had disproved it. He said a recent study showed that HIV occurred across all employment bands.

  This breaking news item was supplied exclusively to by the news desk at our sister publication, The Mercury.

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Poor Scorecards On AIDS Responses For Women. 25/11/09


Women face severe social, legal and economic disadvantages. 
Download report (25p; 1.35 MB) 
JOHANNESBURG, 25 November 2009 (PlusNews ) - That women and girls are particularly vulnerable to HIV and AIDS is well established, but a new report reveals how little we know about what countries are doing, or not doing, to address their vulnerability.

The Scorecard on Women, released on 23 November by non-profit organization AIDS Accountability International (AAI), assessed responses to the specific needs of women in the context of the AIDS epidemic, and the extent to which governments are meeting their commitment to report on those responses.

In 2001, UN member states unanimously adopted the Declaration of Commitment on HIV/AIDS, which included specific targets for prioritizing women in AIDS responses. However, the Scorecard finds that three-quarters of countries are failing to report basic information on HIV services for women and girls.

Globally, HIV is the leading cause of death in women of reproductive age. The 2009 AIDS Epidemic Update, released by UNAIDS this week, noted that women accounted for approximately 60 percent of new HIV infections in sub-Saharan Africa - the region worst-hit by the pandemic - with girls and young women at particularly high risk.

In the nine southern African countries most affected by HIV, prevalence among young women aged 15–24 years was about three times higher than among men of the same age.

"Women's vulnerability to HIV in sub-Saharan Africa stems not only from their greater physiological susceptibility to heterosexual transmission, but also to the severe social, legal and economic disadvantages they often confront," the UNAIDS report pointed out.

The Scorecard on Women rates countries on their reporting of six key elements in an AIDS response tuned to the needs of women, including the collection of HIV data specific to women; progress in ensuring that women have equal access to HIV services; and the impact of national responses on reducing infections among women and facilitating their access to treatment.

An overall score reflects the extent of data provided on each element: countries reporting on all six are characterized as "responsive"; those reporting on only some are described as "aware"; those failing to acknowledge women's particular vulnerabilities to HIV infection are "unfocused". 

Countries with the highest HIV burdens were doing the best job of reporting data detailing their female-centred AIDS efforts, with 67 percent earning the "responsive" rating.

However, the authors noted that a high score for reporting did not necessarily reflect good performance in delivering HIV services for women. Relatively good reporting by South Africa, for example, contrasted with a poor record in improving the maternal mortality of HIV-positive women, or curbing high rates of violence against women.

There was also a disturbing lack of data on the situation of young girls, and what countries were doing to address their particular vulnerabilities. "Because of the almost total lack of data ... this is a scorecard on women, and not on women and girls," they commented.

Dean Peacock, co-director of Sonke Gender Justice, a South African-based NGO that was among several organizations providing input to the Scorecard, welcomed the effort to hold countries more accountable in implementing their HIV/AIDS commitments to women.

"There's been widespread recognition that gender inequality is a contributor to HIV and AIDS, and lots of rhetorical commitments made, but very uneven follow-through," Peacock told IRIN/PlusNews.

He said the Scorecard would provide advocacy groups with useful leverage when pushing countries to reach the UN Millennium Development Goals and other internationally agreed AIDS targets.

Elizabeth Mataka, the UN Secretary-General's Special Envoy on AIDS in Africa, commented: "Women matter, and it is time all governments acted on their commitments to protect women and girls from HIV/AIDS."

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New WHO Report Documents Toll of HIV/AIDS on Women. 10/11/09


A new World Health Organization’s report on women’s health highlights the increasing toll HIV/AIDS has taken on women in the developing world.
November 10, 2009 by dshesgreen
A new World Health Organization’s report on women’s health highlights the increasing toll HIV/AIDS has taken on women in the developing world. HIV/AIDS is “by far the leading cause of death among adult women in Africa,” the report says. It is also the leading cause of death globally among women of reproductive age.
“Of the 30.8 million adults liv­ing with HIV in 2007, 15.5 million were women,” according to the report, “Women and Health: Today’s Evidence, Tomorrow’s Agenda.” “The prevalence of HIV infection in women has increased since the early 1990s and is most marked in sub-Saharan Africa.”
The report details how women’s vulnerability to HIV infection “stems from a combination of biological factors and gender inequality.” Biological differences are “compounded” by cultural/societal restrictions that limit women’s power to have safe sex and to access to information about avoiding HIV infection.  
The WHO study also notes the heavy toll tuberculosis takes on women, as the second leading cause of death in the Eastern Mediterranean and South-East Asia regions and the fifth leading cause of death of women aged 20 to 59. The three leading causes of death in low-income countries are HIV/AIDS, maternal conditions and tuberculosis, which together account for one in every two deaths. This year, the report says, “a mil­lion women will die from HIV/AIDS, half a million from tuberculosis, and another half a mil­lion from complications related to pregnancy and childbirth.”
Click here to read the full report and associated documents.
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Despite Living Longer, Women Get Less Care – WHO. 9/11/09

* Unmarried women and teens deprived of maternal, natal care
* Inadequate aid for mental health problems, sexual violence
* U.N. agency says women deprived their full potential

Mon Nov 9, 2009
By Laura MacInnis

GENEVA, Nov 9 (Reuters) - Despite living six to eight years longer than men, women receive poorer quality care throughout their lives, particularly as teenagers and elderly people, the World Health Organisation said on Monday.

In a report, the WHO said that women around the world are "denied a chance to develop their full human potential" because many of their critical medical needs are ignored.

"Women's longer lives are not necessarily healthy lives," the United Nations agency declared.

While nurses worldwide are predominantly female and mothers, grandmothers and nannies tend to spend much of their lives caring for loved ones, medical services for them can fall short at critical junctures, the WHO report said.

"Paradoxically, health systems are often unresponsive to the needs of women despite the fact that women themselves are major contributors to health, through their roles as primary care givers in the family and also health care providers," it said.

The biggest shortcomings relate to mental health problems and sexual violence, which women suffer more than men, and which many societies prefer to brush aside than confront head-on.

While childbirth services are now highly sophisticated in many countries, reducing death rates for mothers and babies, the WHO found that levels of care often hinge more on a pregnant woman's social standing than her health needs.

"In many countries, sexual and reproductive health services tend to focus exclusively on married women and ignore the needs of unmarried women and adolescents," the report said.

Poverty also plays an important role.

Some 99 percent of the estimated 500,000 women who die every year giving birth are in developing countries where medical supplies and skilled workers are in short supply, the WHO said.

Low-income nations also have minimal screening and treatment services for cervical cancer, the second-most common type of cancer in women, according to the WHO, which stressed that even within individual countries, women from rich families tend to have better health outcomes than those with poorer means.

The report also stressed that some shortcomings affect women spanning across income brackets and geographical regions.

Depression and anxiety affect far more women than men, and women are more likely to catch sexually-transmitted diseases than their male partners due to biological reasons.

Women are also overwhelmingly more likely to be victims of sexual violence than men, and in their elderly years women often find their health problems such as eyesight and hearing loss, arthritis, depression and dementia untreated.

Unequal access to education, employment and fair wages can also present obstacles to women's health, especially in markets where medical insurance is linked to work or where user fees are required to access basic services, the WHO report found.

"Though major differences exist in women's health across regions, countries and socio-economic class, women and girls face similar challenges, in particular discrimination, violence and poverty, which increase their risk of ill-health," it said. (For an associated FACTBOX on the differences between men's and women's health, click here.)

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WHO: AIDS Leading Cause Of Death, Disease In Women. 9/11/09


WHO study shows HIV leading cause of death and disease among women between the ages of 15 and 44.

Washington Post
The Associated Press
Monday, November 9, 2009 3:39 PM
GENEVA -- In its first study of women's health around the globe, the World Health Organization said Monday that the AIDS virus is the leading cause of death and disease among women between the ages of 15 and 44.
Unsafe sex is the leading risk factor in developing countries for these women of childbearing age, with others including lack of access to contraceptives and iron deficiency, the WHO said. Throughout the world, one in five deaths among women in this age group is linked to unsafe sex, according to the U.N. agency.
"Women who do not know how to protect themselves from such infections, or who are unable to do so, face increased risks of death or illness," WHO said in a 91-page report. "So do those who cannot protect themselves from unwanted pregnancy or control their fertility because of lack of access to contraception."
The data were included in a report that attempts to highlight the unequal health treatment a female faces from childbirth through infancy and adolescence into maturity and old age.
WHO chief Dr. Margaret Chan noted that women enjoy a biological advantage because they tend to live six to eight years longer than men. But in many parts of the world they suffer serious disadvantages because of poverty, poorer access to health care and cultural norms that put a priority on the well-being of men, she said.
Chan called it a "preventable tragedy" that nearly 15 percent of deaths in adult women occur in maternity, according to the statistics from 2004. She said the discrimination extends throughout a women's life, from girlhood diseases that aren't identified because they are not sicknesses affecting boys, to clinical trials and medicines developed on the basis of curing adult males.
"We will not see a significant improvement in the health of women until they are no longer recognized as second-class citizens in many parts of the world," Chan told journalists in Geneva. 
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Women And Health: Today's Evidence Tomorrow's Agenda. 9/11/09

Despite progress, societies continue to fail women at key times of their lives

Despite considerable progress in the past decades, societies continue to fail to meet the health care needs of women at key moments of their lives, particularly in their adolescent years and in older age. These are the key findings of the WHO report Women and health: today's evidence tomorrow's agenda.
WHO calls for urgent action both within the health sector and beyond to improve the health and lives of girls and women around the world, from birth to older age.
The report provides the latest and most comprehensive evidence available to date on women's specific needs and health challenges over their entire life-course. The report includes the latest global and regional figures on the health and leading causes of death in women from birth, through childhood, adolescence and adulthood, to older age.
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South Africa Tries To Enlist Men In AIDS Battle. 6/11/09

By Charlotte Plantive (AFP)

JOHANNESBURG — "There is a new man in South Africa," proclaims a new ad splashed across South African media, aiming to transform ideas about sexuality and to enlist the nation's men in the fight against AIDS.

This new South African man's "self worth is not determined by the number of women he can have." He "makes no excuse for unprotected sex" and "respects his woman", the ad reads.

The image of a hard-drinking, fearless seducer still holds powerful appeal for many South African men, posing a major problem to stopping AIDS in a country where 5.7 million of the 48 million population have HIV.

Until now, most AIDS schemes have centred on health centres, which are used mainly by women.

"It is hard to go to a clinic and acknowledge your vulnerability as a man," said Dean Peacock, coordinator at Sonke Gender Justice Network, one of the groups working to engage men.

But men still hold the upper hand in sexual relations, so the "Brothers for Life" campaign aims to convince men to use condoms while also improving their access to treatment.

Currently, women account for three quarters of the HIV tests conducted in South Africa, and two thirds of the anti-retroviral drugs dispensed.

What's more, men tend to seek treatment later than women, when their immune systems are already weakened.

"There is nothing especially made for men. We need to do something to talk to men," said Mzi Lwana, head of the Men and Aids program at the HIV research unit at Witwatersrand University.

Since February, his unit has organised clinics three times a week in downtown Johannesburg, offering consultations only for men.

Patients can meet with a nurse, a social worker or an educator -- all of them men.
"It is much easier to explain to a man," said Victor Makhitsa, one of the patients in nurse Luthando Qobo's office.
"We can go as far as showing our problem... it is like friendship. I feel free to talk to him."
Qobo tries to encourage that relaxed atmosphere to make it easier for people to open up. He doesn't wear a uniform, and speaks to patients in Zulu if they wish.
"It has to be a friendly-user initiative" to help men open up about intimate problems, Qobo said.
"They come mostly for STDs, loss of libido, fertility problems and HIV," he added.
The group is also leading awareness campaigns at football matches, in bars, and in the hostels that are home to many of the workers and taxi drivers known for their machismo.
Also gaining steam are efforts to encourage men to get circumcised, which studies have shown reduces men's risk of infection by at least half.
A major project is underway in the township of Orange Farm, south of Johannesburg, which the Wits research unit's Lauren Jankelowitz said is generating support among other campaigners because it brings men into clinics.
South Africa's health ministry, which recognised in 2007 the need to target AIDS programmes at men, supports these initiatives but still hasn't put together a coherent national plan, campaigners say.
"There isn't yet a government campaign," Jankelowitz said. "We have the support of the government, but it is not yet taking the lead."
Copyright © 2009 AFP. All rights reserved.
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MenEngage Africa Explores Masculinities. 4/11/09

“As men, we are the ones implicated in health and human rights crises across the globe, we as men are therefore essential for a successful resolution - whether it be stopping sexual violence; preventing new HIV infections; expanding treatment and reducing the burden of AIDS care borne by women and girls; increasing men’s active involvement in the lives of their children; strengthening health systems or promoting a more active sense of citizenship aimed at holding government to account for their commitments.” Sandi Mbatsha, on behalf of Noluthando Mayende-Sibiya, Minister for Women, Children and Persons with Disabilities, at the opening of the MenEngage Africa Symposium, 5 October 2009.
In his opening address at the MenEngage Africa Symposium, held in Johannesburg in early October 2009, Mbatsha, Special Advisor for the Department for Women, Children and Persons with Disabilities succinctly summarised the importance of engaging men in gender justice: men are perpetrators of violence, men are key transmitters of HIV, and consequently, men can be powerful agents of change. It is this final point which participants at the symposium rallied around. The delegates, more than half of whom were men, discussed men’s role in gender-based violence and HIV, looking at ways in which to work with men, change attitudes, present new role models, and mobilise men against gender-based violence and HIV.
Participants at the event were reminded of the scope of the problem: worldwide an estimated 30 percent of women suffer physical violence at least once from a male partner, and nearly 20 percent of women say that their first sexual experience was forced. Additionally, women worldwide only earn 80 percent of what their male counterparts earn, while spending three to four times more time in caring for children and other domestic activities. Women also bear the brunt of the HIV epidemic, with women being more vulnerable to HIV (biologically and socially) and carrying the burden of care for those ill with AIDS. The link between gender-based violence and HIV was also emphasised - violence against women increases women’s vulnerability to HIV, and their HIV status sometimes results in violence.
Throughout the event, speakers emphasised how women’s inequality and violence against women affects all members of society. Foremost, it threatens the health, well-being and lives of women and girls. It violates inherent rights to dignity, equality and freedom. It places women and girls at greater risk of contracting HIV and it undermines women’s self-sufficiency.
Gender inequality and gender-based violence also affect children (boys and girls), destroying feelings of security, raising barriers to education and establishing negative role models for future behaviour. Pascal Akimana, a delegate from Burundi, noted in his personal testimony, “Before I started doing this work, I was a dangerous young boy. I think this is because of the violence that I experienced in my growing up time. I remember I used to be very angry at any child or person. Many times I would fight and this led me to join a bad group of people who were abusing women and girls.” Now Pascal works for EngenderHealth and is committed to honouring his mother’s experience by working with men and boys to end gender-based violence.
Francois Venter, president of the Southern Africa HIV Clinician’s Society noted how stereotypical notions of masculinity and men’s roles negatively impact on men, placing men in mortal danger from violence (through homicide, car accidents, war and other men-on-men violence) and untreated disease (especially HIV). Traditional male stereotypes also limit men’s ability to become actively involved as fathers and caregivers in their communities. Co-chair of the MenEngage global alliance, Gary Barker, recited an extensive list of statistics detailing why it is important for men to be actively involved in raising their children, “According to global research, the impact of involved fatherhood includes lower incidences of substance abuse, better performance at school, delayed sexual debut, and reduced participation in criminal activities, and yet a review of 156 cultures, shows that only 20 percent promote close relationships between fathers and infants.”
Barker’s work to advocate for paternity leave was one of the many projects that the 240 delegates - representing 25 countries - heard about. Other campaigns and projects that were showcased include campaigns for reducing multiple concurrent partnerships, programmes for working with refugees and initiatives to address violence against sexual minorities. Delegates also heard about the impacts that these projects are starting to have. Researcher Chris Colvin reported that 27 percent of participants in Sonke’s One Man Can workshops go for an HIV test soon after the workshop, while two-thirds of participants report increasing their use of condoms after the workshop.
Panels also discussed the roles and responsibilities of various groups in relation to transforming gender stereotypes. Religious leaders and media spokespersons debated the roles that they could and should play in changing attitudes, promoting new notions of masculinity and challenging sexist and violent behaviour. Women’s rights organisations shared their knowledge and experience and proposed ways for stakeholders working towards gender justice to work together. Throughout, youth participants reminded delegates of the importance of including young people in all phases of programme development, demonstrating the powerful role that the youth can play in changing attitudes and promoting new role models.
As one of the delegates put it: "I am a young man with a dream, a dream of a future, a prosperous future, where men, women, boys, and girls, young and old are equal and enjoy gender equitable lives; where men and women are regarded equally and not treated differently based on their faces and sex; where boy and girl children have equal opportunities, at home, at school and in public places. Yes, I am a real young man working for that future. And that future is now."
Researchers also shared their latest findings, highlighting the intersection between gender inequality and HIV. Research conducted by the Perinatal HIV Research Unit and Emory Global Health Initiative, for example, gave insight into the role that perceptions of masculinity play in spreading HIV and in dealing with an HIV positive diagnosis. Their research found that although HIV challenges ideals of sexual prowess and threatens ideals of male strength, some men have managed to reconcile their HIV positive status and masculinity by proactively taking on advocacy, leadership and peer-education roles in their communities, and also through supporting others. These findings have exciting implications for organisations working with men to prevent the transmission of HIV and reduce the stigma surrounding the disease.
Although this event marks an important step in getting recognition for the critical need to work with men and boys to end gender-based violence and prevent HIV, there is still an enormous amount of work that needs to be done: national and international policies and treaties need to include specific provisions around working with men; funders need to make additional funds available to support this work, without reducing the funding made available to women’s rights organisations; additional research needs to be implemented documenting the impact that working with men and boys has on attitudes and behaviours; and programmes need to be developed and strengthened to target specific groups of men and boys, such as armies, police forces and prison populations.
These challenges have been documented in the Johannesburg Declaration and Call to Action which highlights areas in which specific action can be taken to strengthen work with men and boys. In addition to setting out specific actions that various stakeholders can take, the Call to Action generally calls on “individual men and women, youth, media, civil society, donors, private sector, governments and UN agencies to support the MenEngage Alliance and reaffirm their commitment to preventing gender-based violence and HIV by committing to working with men and boys.”
Anyone interested in joining the MenEngage Alliance or finding out more about the Symposium or the Johannesburg Declaration and Call to Action can visit the MenEngage and Sonke websites: and
Helen Alexander is the Communication and Information Manager at the Sonke Gender Justice Network
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Brothers Are Doing It For Themselves. 8/10/09

JOHANNESBURG, 8 October (PLUSNEWS) - In the context of sub-Saharan Africa's HIV/AIDS epidemic, women have often been characterized as the victims and men as the perpetrators incapable of sticking to one partner or taking responsibility for their sexual health.
 But what if men were victims of the social norms that define masculinity as much as women? And what if they were willing to change, and persuade other men to do the same?
 Speakers at the MenEngage Africa Symposium in Johannesburg, South Africa, this week have been debating ways to help men achieve this and to become part of the solution to the continent's twin epidemics of gender-based violence and HIV.
 "When we talk about a feminized epidemic, we make the mistake of leaving men out of interventions," commented Mandla Ndlovu, programme officer of the recently launched "Brothers for Life" campaign.
 The initiative by Johns Hopkins Health and Education in South Africa (JHHESA), USAID and the Sonke Gender Justice Network aims to spark a movement of "good" men to encourage their peers to take more responsibility for their health and that of their partners.
 One presentation indicated that there may be more good men out there than we think. In a recent study on multiple partners in four locations across South Africa, 74 percent of men reported having had only one sexual partner in the past year.
 "While the prevalence of men having multiple partners is quite high, it's not as normative as has been suggested," said Sarah Laurence of Health & Development Africa (HDA), a health consultancy that conducted the research on behalf of JHHESA.
 Although men are less affected by HIV than women in high-prevalence countries like South Africa, they are far from invulnerable: 24 percent of South African men aged 25 to 49 are living with the virus.
 Because men are far less likely than women to seek out HIV testing, treatment and support, they experience worse outcomes from HIV and other chronic illnesses, according to Dr Francois Venter, director of the Southern African HIV Clinicians Society.
 Venter urged delegates not simply to blame men for their poor health-seeking behaviour, but to consider some of the reasons for it. Some presenters focused on the fact that men were socialized to consider illness a sign of weakness, and tended to perceive an HIV-positive diagnosis as a humiliating blow to the ideal of masculine strength, but Venter suggested that South African public healthcare facilities were also to blame for not responding to men's specific needs, and not prioritizing interventions such as male circumcision, which could reduce their HIV risk. "How can we expect men to change their behaviours if we're failing them on a public health level?" he asked.
 The "One Man Can" campaign by Sonke Gender Justice - launched in late 2006 with the goal of supporting men and boys to become advocates for gender equality and active participants in HIV/AIDS responses - has already demonstrated that men are capable of changing their behaviour and attitudes.
 Dr Chris Colvin presented an evaluation of the campaign's impact, based on interviews with 265 participating men, which found that 75 percent had increased their use of condoms, 23 percent had gone for voluntary counselling and HIV testing, and 83 percent of those who had witnessed gender-based violence had reported it.
© IRIN. All rights reserved. HIV/AIDS news and analysis:
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The Equality Courts As A Tool For Gender Transformation. 8/9/09

 NGO Pulse  

In March 2009, Sonke Gender Justice Network filed a complaint at the Equality court in Johannesburg against the ANC Youth League Leader, Julius Malema. The complaint was lodged in response to remarks he made to university students concerning Jacob Zuma’s rape accuser claiming that she likely enjoyed herself during the incident. Sonke’s Equality Court case alleges hate speech, unfair discrimination and harassment of women, and is only the second high profile gender equality case to be taken to the Equality Courts since their inception in 2003 (1). This case study provides an analysis of the Equality Courts as a new legal forum for gender transformation work by examining the history and theoretical foundations for the courts, the procedures for utilising the courts, the problems and challenges faced when using the courts, and documenting Sonke’s own experiences in lodging its case.
In January 2009, the African National Congress’ outspoken and wellknown youth leader, Julius Malema, addressed 150 Cape Peninsula University of Technology students. Already controversial for making inflammatory remarks in which he said he would be willing to “kill for Zuma,” Malema suggested that the woman who accused President Zuma of rape had a “nice time” with him because “when a woman didn’t enjoy it, she leaves early in the morning. Those who had a nice time will wait until the sun comes out, request breakfast, and ask for taxi money.”His words were met with cheers by the student supporters.
However, many others were outraged. Human rights and gender equality organisations such as Sonke Gender Justice Network (Sonke) were worried about the impact such words would have in a country with alarmingly high levels of rape, where pervasive rape myths result in rape survivors often being blamed for rape and retraumatised in the country’s police stations and courts. Sonke’s Senior Programme Advisor, Mbuyiselo Botha, explained:
“Malema’s words send a very dangerous message to the country at large. South Africa has one of the highest incidents of rape in the world. If people making statements such as these aren’t made accountable, then they detract from the gains we’ve made toward gender equality.”
Recent research reveals a dire picture of violence against women and sexual assault in South Africa. A survey in the Eastern Cape and KwaZulu-Natal provinces by Professor Rachel Jewkes of the Medical Research Council and colleagues from the University of KwaZulu-Natal, ‘Understanding men’s health and use of violence: interface of rape and HIV in South Africa’, revealed that 1 in 4 men surveyed admitted to having raped a woman.
The study also found that men who are physically violent towards women are twice as likely to be HIV-positive, and are less likely to use condoms. Any woman who has been raped by a man over the age of 25 has a 1 in 4 chance of her attacker being HIV-positive. These alarming figures, Jewkes posits, are linked to ideas about masculinity based on gender hierarchy, and to a sense of entitlement to sex evident amongst many men.
The situation is exacerbated by misconceptions regarding sexual violence. A survey of 250 000 school aged youth indicated that males were more likely than females to believe that “sexual violence does not include touching; sexual violence does not include forcing sex with someone you know; girls have no right to refuse sex with their boyfriends; girls mean yes when they say no; girls like sexually violent guys; girls who are raped ask for it; and girls enjoy being raped” ‘Literature review on men, gender, health and HIV and AIDS in South Africa’ for Sonke Gender Justice.
With this social context in mind, Sonke began seeking avenues of redress. Mbuyiselo Botha explained, “[Malema] is of high profile and influential, so he should be careful and sensible because young people look up to him.” As an organisation that supports men and boys to take action to achieve gender equality, Sonke saw this as an opportunity to prompt discussion about men’s roles and responsibilities in both colluding with and challenging the pervasive rape culture.
Research on gender activism in South Africa indicates that to date, “organisations working with men have only occasionally used rights-based activism and have focused almost exclusively on community education.” Because of this over-reliance on workshops and community education strategies, “much remains to be done to make work with men truly transformational.” Sonke felt the effort to hold Malema accountable provided an important opportunity to experiment with rights-based advocacy as a gender transformation strategy.
Sonke contacted the relevant institutions mandated by the Constitution to serve as human rights watchdogs, in this instance, the Commission on Gender Equality and the South African Human Rights Commission, before turning to the Equality Courts. The case has provided an opportunity to test the Equality Courts as a new tool for engaging men in the advancement of gender transformative work.
Co-Director of Sonke, Dean Peacock, elaborated: “advocacy offers the possibility of generating enough controversy and media coverage to engage millions of people across the entire country in meaningful conversations. [The case against Malema] also offers the possibility that it might fundamentally shape the ways in which leaders think about how they address gender transformation, and in particular, how they address rape.”
Click here to read the full case study.

This case study was written by Sonke Intern, Emily Keehn. To find out more about Sonke Gender Justice’s work and read more case studies, visit their website at


1. The Department of Justice and Constitutional Development [DOJCD] notes that “the gathering of statistics on the cases presided over by the Equality Courts is proving to be a challenge.” Decisions are not published in an official reporter, so this figure is an estimate. DOJCD Annual Report 2007-2008, p.51, available at
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Protecting Mothers, Sisters & Partners From HIV 5/9/09


Non-governmental organisations have raised concern over the lack of female condoms claiming that it undermines efforts to curb new infections.
“In South Africa more than 1 000 people are newly infected (with HIV) every day. The majority of those are women. The epidemic in this country has the face of a woman. Advocacy towards prevention has been really weak”, said Nomfundo Eland, Chairperson of SANAC’s women’s sector. Eland was addressing the recently-held “HIV Prevention for Women and Girls Summit”, in Johannesburg.
She referred to the latest research by the Human Sciences Research Council, which shows that, “females from the ages of 25 - 29 have the highest (HIV) prevalence in South Africa at about 32, 7 percent. The national average is 10, 9 percent”.
“There is a need to protect them (women) from the factors that put them at risk, issues such as the economic status of women, issues like gender-based violence, inaccessibility of prevention measures that are directed at women, like female condoms”, she said.
“South Africa has great policies and yet failure to implement these policies undermines efforts in totality. Inequalities that exist in our strategies, such as the distribution of condoms - for instance, about 3 500 000 condoms for women are distributed and 450 000 000 male condoms are distributed. That means four women will be sharing one condom’, she continued.
In defence of the Health Department, Eva Marumo, its HIV and STI Prevention Unit Head, said, “the department is buying female condoms from (its) own fiscal. There’s no donor supporting that, currently”.
However, advocates of female condoms, disagree. Tian Johnson, Advocacy Officer of the Thohoyandou Victim Empowerment Programme (TVEP), raised concern over the awarding of the tender for the manufacture of female condoms. 
“The current situation pertaining to the inadequate access to the female condom in South Africa today is a violation of the rights of women and men of this country. The tender for female condom supply has been awarded the “Female Health Company”. That means there are no options for competition, there are no options for bringing prices down. That enables us to use the excuse that we have been using for far too long, the excuse that$, female condoms are too expensive. It’s an excuse with no basis and with no merit”, he said.
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Real Men are Brothers for Life. 3/9/09

Lyn's Comment:  We all read the statistics of the 'feminization' of the HIV epidemic.  Women are often portrayed as 'victims' of 'violent', 'promiscuous' and 'uncaring'.  The danger of this polarisation should be clear. A more positive response would be to strengthen and highlight the positive role of men.  A programme initiated in South Africa aims to do just this:

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Breeding Men, Not Tigers. 02/09/09

Living with AIDS # 403
02.09.2009 Khopotso Bodibe

The stereotype that most South African men are abusers who spread HIV and are incapable of loving and caring, is being challenged. A new campaign in South Africa, “Brothers for Life” is urging men to show that they are also human and can do what is good.

This USAID-funded campaign, “Brothers for Life”, promotes the positive values that men should stand for. Part of it is a media awareness programme whose first advert started appearing this week. The advert publicises a manifesto that introduces the arrival of a “new man” in South Africa.

This new man is the type that takes responsibility for his actions, a man who chooses a single partner over multiple chances with HIV, a man whose self-worth is not determined by the number of women he can have, a man who makes no excuses for unprotected sex - even after drinking, a man who supports his partner and protects his children, a man who respects his woman and never lifts a hand to her, a man who knows that the choices we make today will determine whether we see tomorrow.

But the man envisioned here “is not entirely new”, says Mandla Ndlovu, Communications Manager for Johns Hopkins Health and Education in South Africa, an implementing partner in the campaign.

“The problem is that this type of man is silent, hence he is not known to exist”, he says, adding that “what is new is that this man speaks about it and is out there and he’s proud to stand up for these values. I think we all know good men. But, good news does not sell. What you hear more about South African men are the men that rape, abuse their women, abuse children. This campaign aims to lift out the voices of these other men, who actually are the big majority of South African men”.

Instead of preaching to men, the campaign seeks to create an environment where men can learn from one another about how to become better people, partners and parents.

“There are a lot of men out there who can teach, there’s a lot of men who are good parents, there’s a lot of men who actually practice great behavior and we would like that silent majority of men to come out and educate the rest of the men about how to be a good man in the context of South Africa in these dangerous times”, says Ndlovu.

Sonke Gender Justice Network, which educates boys and men about their responsibility in social and health issues, is a partner in the project. Co-director, Bafana Kumalo, explained that the aim “is to focus on a group of society that has largely been ignored in health intervention programmes”.

“It’s an intervention that is focusing primarily on men on issues of HIV/AIDS and broadly health and wellness for men. It’s targeted, particularly, at ages of men from 30 upwards because having looked at most of the interventions that we have in the country currently that speak to the issues of HIV/AIDS, for instance, target younger generations. We felt there is a need, really, to have a programme that speaks specifically to mature men, particularly in the light of Soul City’s research that confirms issues of concurrent multiple partners as one of the drivers of the pandemic in the country”, Kumalo said.



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Looking for Brothers for Life. 01/09/2009

Kerry Cullinan

Too often, South African men are painted as violent, abusive and dangerous. Brothers for Life is out to promote the silent good guys.  

This is the essence of the “Brothers for Life” campaign, being launched on Saturday (29 Aug) in KwaMashu – one of South Africa’s most violent townships and a community badly affected by HIV/AIDS.

“We want to break the silence, and mobilise men around the real values that define being a man in South Africa,” says Mandla Ndlovu, from Johns Hopkins Health and Education SA (JHHESA), one of the campaign partners.

JHHESA, Sonke Gender Justice, the Department of Health, SA National AIDS Council and USAID, have drawn up a manifesto which will be promoted by over 30 organisations in communities throughout the country after the launch.

The aim is to encourage communities to identify and support local male role models as part of an effort to get men to take responsibility for stopping the spread of AIDS.

The manifesto urges men to be a “brother for life” by:

- Choosing “a single partner over multiple chances with HIV’

- Making ‘no excuses for unprotected sex, even after drinking alcohol”

- Supporting their partner while pregnant, and protecting their children from HIV infection – mainly by testing for HIV and encouraging their pregnant partners with HIV to take medication to prevent infecting their baby and supporting their choices around only breast feeding or only using formula feed.

- Respecting their partners and “never lifting a hand to them”

- Taking care of themselves by going for medical check-ups and choosing a healthy lifestyle that includes exercise, healthy eating and limited alcohol.

Despite research that shows that South African men are among the most violent in the world, what is not often recognised is that our macho culture also makes men very vulnerable to death and disease.

 “Men think of ill-health as a sign of weakness which is why they go to a doctor less often than women,” according to a Khayelitsha survey.

And the health statistics bear this out. Only one-fifth of all the people being tested for HIV were men, according to a recent national study of VCT services. Yet people who know their HIV status are more likely to use condoms – our only known way to prevent HIV transmission during sex.

Men account for about one-third of all people on antiretroviral treatment, yet based on infection rates, roughly 45% of those on ARVs should be men. Men also seek help for AIDS later than women, when their immune systems are more damaged and their chances of recovery are not that good.

 In addition, masculinity is often equated with “sexual conquest” and having more than one sexual partner at a time, according to research conducted by Sonke Gender Justice.

 But “one of the most significant factors driving the spread of HIV across sub-Saharan Africa” is “multiple and concurrent sexual partnerships” and “having more than one sexual partner at the same time is a strong predictor of HIV infection”, says Sonke.

Widespread alcohol abuse also makes men more likely to have casual sex without a condom or get involved in violence.

Gender based violence is also fuelling HIV infection in South Africa. Our levels of rape are among the highest in the world (and conviction rates among the lowest), while domestic violence is widespread.

Almost seven out of 10 domestic violence cases in the Cape Metropolitan area were alcohol related, according to the Medical Research Council. Another study found that South Africans who regularly had five or more drinks at a time were more likely to be HIV-positive.

“Although much good work has been done to engage men in efforts to reduce gender inequality, most programs have been small in scale and had limited sustainability,” says JHHESA’s Ndlovu.“ If South Africa wants to stop the spread of HIV/AIDS and enhance the physical and psychological health of all its people, it is time to bring men on board,” says JHHESA’s Mandla Ndlovu.

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Lovers, Fathers And Brothers 26/8/09


JOHANNESBURG, 26 August (PLUSNEWS) - The days of South African men waiting at the kerbside while girlfriends and wives queue at the clinic for antenatal visits are gone; a new programme aims to create a new idea of what makes a man, and turn the tables on the old one.
 Starting on 29 August the "Brothers for Life" campaign hopes to make men in their 30s more responsible for their health and their partners' by looking seriously at issues like multiple concurrent partnerships, low HIV testing rates and generally poor health-seeking behaviour - from a man's perspective.
 South Africa's national HIV prevalence rate is about 11 percent, but men aged 25 to 49 have an infection rate of about 24 percent - more than double the average according to the results of the third national HIV survey by Human Sciences Research Council, released in June.
 The Johns Hopkins Health and Education in South Africa has partnered with USAID and Sonke Gender Justice, which works to address social aspects of the HIV epidemic, with a particular focus on gender, in spearheading the project.
 The issues may not be new, but the organizers hope the high-profile campaign's novel approach will break through to what has been a neglected population in the country's fight against HIV/AIDS, said Bafana Khumalo, co-director of Sonke Gender Justice.
 Many of the largest HIV prevention programmes, such as Soul City and LoveLife, target teenagers and youth, despite the real need for HIV prevention amongst this high-risk group, Khumalo said.
 The statistics on men's roles in everything from condom use to rape, while important, may have overshadowed the reality of some South African men, said Richard Delate, country programme director of Johns Hopkins Health and Education in South Africa.
 "We know that the majority of men have one partner, we know the majority of men use condoms, and that the majority of men do not consume alcohol in excessive amounts," Delate told IRIN/PlusNews. "Brothers for Life is aiming to create a movement of men around the real values that underpin South African men."
 The problem is that these men often do not admit to being the "good guy" said Nhlanhla Vezi, a facilitator at The Valley Trust, a health NGO based in KwaZulu-Natal and one of more than 30 NGOs implementing the Brothers for Life project. "A man may lie and say he has three girlfriends but, in reality, he might have no partner at all."
 Sex between older men and younger women is indicated as a primary driver of the high HIV prevalence rates, but Delate said men who signed up for the "Brothers for Life" movement might dent the rate of new infections as men adopt safer sex practices, and start talking about them.
 From community hero to campaign pin-up
 The campaign goes beyond the bedroom, encouraging men to take an active and early role in parenting, starting with their participation in prevention of mother-to-child transmission (PMTCT) services to their partners. Vezi said the men he worked with were excited about a programme that did more than stereotype them as violent and irresponsible.
 "Men always say, 'We want to be trained in term of issues of PMTCT and to understand partners.' They say there is too much criticism from women saying they don't participate," he said. "Men are saying, 'We don't know how to help you, we can only drive to the clinic and wait in the car while you stand in line.'"
 The ladies have already had their say in the campaign's mass media component, nominating many of the men featured in the posters and TV adverts.
 Creative Director Xolisa Dyeshana was part of the team at Joe Public, the South African advertising firm that produced the campaign's slick upmarket look. Rather than using actors or models in TV adverts and billboards, the team opted to use men that women said embodied the campaign's ethos of responsibility and wellness.
 "We went into different communities and introduced the concept to women, and asked them to nominate men they felt represented these values," Dyeshana told IRIN/PlusNews.
 "There was no wardrobe, no make-up. The guy you see in the PMTCT ad - that's really his partner and they're really expecting a child," he said. "We're trying to create a new social norm."
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Women Are More Vulnerable To HIV - Motlanthe 21/08/09

BUA News

The majority of women remain the victims of the HIV epidemic, says Deputy President Kgalema Motlanthe.
"We acknowledge as the government of South Africa that women are more vulnerable to HIV than their male counterparts.
"We also acknowledge that year after year women form the majority of those infected by HIV - indeed almost 60 percent of all new infections now occur in women," Mr Motlanthe said at an HIV Prevention for Women and Girls Summit on Friday.
For younger women, he said, the situation was even more tragic. "For younger age groups women could represent up to 76 percent of all those who are infected," he said.
He said women disempowerment was among the key drivers of the HIV epidemic despite the gains made since 1994.
"Many women, especially those who live in poor settings do not have the ability or the knowledge to negotiate safer sex, this despite the fact that we have a constitution that is deeply rooted in a human rights culture," Mr Motlanthe said.
Poverty, multiple concurrent partners and gender-based violence all contribute to maintaining high infection rates in the country, he said, urging the public to work harder together to rid society of such ills.
"I am confident that if we jointly mount a multi sectoral response that is of sufficient intensity, duration and scope we can address many of the issues we face today that make women in particular vulnerable to HIV infection.
"This remains a priority issue and needs to be addressed on all fronts, the development and implementation of tools that can be used by women to protect themselves, such as female condoms is an imperative," Mr Motlanthe said.
He added that the journey to HIV control will not be fought and won only by South African National AIDS Council (SANAC) or the Department of Heath, but will require many partners.
He vowed that government shall not rest until women have power over AIDS, control over their own bodies and power over their lives.
"Together we can minimise the impact of this dreadful pandemic and ensure that we create conditions for HIV free generation," said Mr Motlanthe.
He said government and its partners are taking these challenges very seriously, in their National Strategic Plan (NSP) for HIV and AIDS and STIs, 2007-2011. "We have clearly identified the target of halving the rate of new HIV infections by 2011.
"This is not merely rhetorical, for the sake of our people and our country we must reduce the rate of new infections - we simply have no choice," Mr Motlanthe said.
In an effort to reduce the number of new infections government has introduced a number of programmes and initiatives including the distribution of male and female condoms, Prevention of Mother to Child Transmission programme, voluntary counselling and testing.
Government has also introduced syndromic management of sexually transmitted infections, life skills programmes in schools and a range of information including educational and communication strategies like Khomanani campaign.
The two-day summit, which started on Thursday, will be used as a platform for information sharing and discussions on meeting the NSP target to reduce the rate of new HIV infections by 2011.
The summit also aims to provide a platform for women and the many HIV organizations and decision makers who support them to have an opportunity to review the implementation challenges of the NSP for HIV and AIDS and STDs 2007-2011, particularly focusing on women and their vulnerability to HIV.
The recommendations formulated at the summit will be given to SANAC. – BuaNews
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Figuring Out Why AIDS Hits Women Faster. 18/07/09

July 18, 2009
BY Monifa Thomas Health Reporter 

Scientists have long wondered why women infected with HIV progress to full-blown AIDS faster than men who have a similar viral load. New research suggests that gender differences do, in fact, affect how the immune system responds to the virus. The findings, published in the journal Nature Medicine, could lead for new therapies to treat the virus.

Scientists from the Ragon Institute at Massachusetts General Hospital, MIT and Harvard University studied immune cells known as plasmacytoid dendritic cells, which are among the first in the body to recognize HIV. They found that cells taken from HIV-negative women triggered a stronger immune response when exposed to the virus than cells taken from uninfected men.

Hormones could be to blame for this difference, since higher levels of the female hormone progesterone were linked to an increased immune response to HIV.

"While stronger activation of the immune system might be beneficial in the early stages of infection . . . persistent viral replication and stronger chronic immune activation can lead to the faster progression to AIDS that has been seen in women," said lead researcher Dr. Marcus Altfeld.

The research team theorized that dendritic cells exposed to HIV stimulate the activation of other immune cells known as CD8 positive T cells, which have been shown to be a good predictor of how quickly HIV becomes AIDS. When they tested blood samples taken from HIV-positive men and women, researchers found that women did have much higher levels of these T cells than men with the same viral load.

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Why AIDS Hits Women Faster. 18/7/09

Lyn's Comment: Much has been written about HIV and women - we hear about the 'feminization' of the epidemic in Africa; the unequal 'burden' of care on women. Research now also suggest that the effect of the virus on immuun systems of women also differs.

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Rape And HIV In South Africa 19/06/09

Understanding Men’s Health And Use Of Violence: Interface Of Rape And HIV In South Africa

Rachel Jewkes, Yandisa Sikweyiya, Robert Morrell and Kristin Dunkle
Gender & Health Research Unit, Medical Research Council, South Africa,
June 2009
Download Executive summary (5 pp. 30 kB)


South Africa has one of the highest rates of rape reported to the police in the world and the largest number of people living with HIV. The rate of rape perpetration is not known because only a small proportion of rapes are reported to the police. There is considerable concern about the links between these two problems. Obviously HIV can be transmitted in the course of rape and this compounds the human rights violation of the rape. Research has established that men who rape and are physically violent towards partners are at more likely to engage in sexual risk taking than other men and this has raised a concern that they are more likely to be infected with HIV. The aim of this research was to understand the prevalence of rape perpetration in a random sample community-based adult men, to understand factors associated with rape perpetration, and to describe intersections between rape, physical intimate partner violence and HIV.


The study was conducted in three districts in the Eastern Cape and KwaZulu Natal Provinces – spanning geographical areas: rural, urban and city. It was a crosssectional with a two stage random sample. The sample was drawn by Statistics South Africa. Following a cluster design, 222 enumeration areas (ea) were selected and 20 households approached per ea for interview. One man aged 18-49 years interviewed per household. Interviews followed a questionnaire and were administered via APDAs (Audio-enhanced Personal Digital Assistants). A finger prick specimen of blood was requested for HIV testing and collected as a blood spot which was dried.

Blood was tested for HIV in the laboratory of the National Institute for Communicable Diseases in Johannesburg, using ELISA. Ethics approval was given by the Medical Research Council’s ethics committee. We completed interviews in 215 of 220 eligible eas (97.7%) and we completed interviews in 1,738 of 2,298 (75.6% ) of the enumerated and eligible households.


The sample included men of all racial groups and of a range of different socioeconomic backgrounds. Half of the men were under 25 years of age and 70% were under 30. The population was some what younger than men in the general population.

Rape prevalence

Rape of a woman or girl had been perpetrated by 27.6% of the men interviewed and 4.6% of men had raped in the past year. Rape of a current or ex-girlfriend was disclosed by 14.3% of men. Since many men had raped more than once, rape of a woman or girl who was not a partner was actually more often reported than rape of partners. In all only 4.6% of men had raped a partner and not raped a woman who was not a partner (i.e. an acquaintance or stranger). 11.7% of men had raped an acquaintance or stranger (but not a partner) and 9.7% had raped both. In total, 8.9% said they had raped with one or more other perpetrators when a woman didn’t consent to sex, was forced or when she was too drunk to stop them. Rape of men and boys was also reported, 2.9% said they had done this. Attempted rape was reported by 16.8% of men and 5.3% of men said they had done so in the previous 12 months.

Patterns of rape

Nearly one in two of the men who raped (46.3%) said they had raped more than one woman or girl. In all, 23.2% of men said they had raped 2-3 women, 8.4% had raped 4-5 women, 7.1% said they had raped 6-10 and 7.7% said they had raped more than 10 women or girls.

Asked about their age at the first time they had forced a woman or girl into sex, 9.8% said they were under 10 years old, 16.4% were 10-14 years old, 46.5% were 15-19 years old, 18.6% were 20-24 years old, 6.9% were 25-29 years and 1.9% were 30 or older.

Factors associated with raping

Age was significantly associated with the likelihood of having raped, with men aged 20-40 were more likely to have raped than younger or older men. Education was also associated, with men who had raped being significantly better educated, although they were not more likely to have a tertiary qualification. There were significant racial differences in rape reporting, mostly notably men who were Coloured were over represented among those who had raped. Men who had raped were significantly more likely to have earnings of over R500 per month, although they were not more likely to be in the top income bracket, over R10 000.

Men who raped were more likely to have occasional work and less likely to have never worked at all. 

Parental absence was significantly associated with raping, as was the quality of affective relationships with parents was related to raping. Men who raped perceived both their fathers and mothers to be significantly less kind (p<0.0001). Rape was associated with significantly greater degrees of exposure to trauma in childhood. 

Teasing and harassment, or bullying, were reported by many of the men in their childhood. Over half of the men had experienced this themselves (54%) and somewhat fewer (40%) had teased and harassed others. Both experience of bullying and being bullied was much more common among men who raped. Delinquent and criminal behaviour were more common among men who raped. Men who raped were much more likely to have been involved in theft and, with the exception of legal gun ownership, they were very much more likely to have been involved with weapons, gangs and to have been arrested and imprisoned.

Men who disclosed having raped were significantly more likely to have engaged with a range of other risky sexual behaviours. They were more likely to have ever had more than 20 sexual partners, transactional sex, sex with a prostitute, heavy alcohol consumption, to have been physically violent towards a partner, raped a man and not to have used a condom consistently in the past year.

Associations between rape and HIV

The HIV prevalence among men who had raped was 19.6% and 18.1% among those who had never raped. This difference was not significant (p=0.53). The HIV prevalence was lower, 12.7%, among those who had raped in the past year. Men who had raped another man, in contrast, had a higher prevalence of HIV (27.8%).

The most striking feature of the age-specific HIV prevalence, when plotted for men who have and have not raped, is the very high prevalence of HIV for all men in this sample. The prevalence among all men aged 25-45 was in excess of 25%, and among those aged 30-39 years, over 40%. When examined by rape perpetration status, however, there was no overall difference between the HIV prevalence of men who had raped women and those who had never raped.

Associations between physical intimate partner violence and HIV

In all 42.4% of men had been physically violent to an intimate partner (current or ex girlfriend or wife). Asked about physical violence in the past year, 14.0% (95%CI 12.4, 15.7) of men disclosed perpetration. Men who disclosed violence were very much more likely to have engaged in a range of risky sexual behaviour, as well as to have raped and been raped.

A logistic regression model of factors associated with having HIV showed that men who had been physically violent to a partner on more than one occasion were significantly more likely to have HIV (OR 1.48 95% CI 1.01, 2.17, p=0.04). Other associated factors were being African, rather than of another race group, being 25 or older, and having had a genital ulcer.

Those who had completed matric at school or attended tertiary education and those who were circumcised were less likely to be infected.


The findings highlight the very high prevalence of rape in South Africa and the high prevalence of HIV in the adult population. The prevalence of rape has similarities to that found in other studies in South Africa. The very high prevalence shows that generally rape is far too common, and its origins too deeply embedded in ideas about South African manhood, for the problem which can be predominantly addressed through strategies of apprehension and prosecution of perpetrators.

A much broader approach to rape prevention is required. This must entail intervening on the key drivers of the problem which include ideas of masculinity, predicted on marked gender hierarchy and sexual entitlement of men. Efforts to change these require interventions on structural dimensions of men’s lives, notably education and opportunities for employment and advancement. Our study suggests that the pathway which leads to these ideas and the practices of rape and other forms of violence towards women starts in childhood and strengthening families, and protecting children from exposure to adversity in childhood are critical for ensuring that men in the population develop psychologically as pro-social members of society.

A very surprising finding of our study was that men who raped were no more likely to have HIV than men who hadn’t raped. Yet one of the very important findings is the very high HIV prevalence found in all the men, but particularly those aged 25-45.

This provides a salient reminder of how likely it is that a man who rapes has HIV, irrespective of whether he has more than another man. Clearly post-exposure prophylaxis for HIV after rape is a very important part of post-rape care for victims who are HIV negative.

The fact that so many rapes are gang rapes, or involve multiple acts of sex penetration (30% in cases reported to the police) and the high prevalence of injuries (at least 58% in rapes reported to the police) (Vetten et al 2008) further supports the very considerable risk of exposure to HIV of victims at the time of rape and risk of transmission through rape.

The factors that were shown to be associated with having HIV in the study are in many respects unsurprising. Its well known that the epidemic has disproportionately spread amongst Africans, that the most well educated are relatively more protected, that having genital ulcers increases the likelihood of having HIV and that circumcision is protective. What has previously been suspected, but not shown in research, is that men who are physically violent towards their intimate partners are more likely to have HIV. This finding is completely congruent with the documented association between being violent and sexual risk taking, and indeed the finding that women who experience violence are more likely to have HIV (Dunkle et al 2004).

This is explained by an underlying construction of masculinity which is predicated on use of violent and sexually behaviours. It has been argued that this is a key driver of the HIV epidemic and our finding supports this. HIV prevention needs to embrace and incorporate promoting more gender equitable models of masculinity. The intervention

Stepping Stones, has been shown to effectively do this, and should be promoted

(Jewkes et al 2008).


1. Rape prevention must focus centrally on changing social norms around masculinity and sexual entitlement, and addressing the structural underpinnings of rape.

2. Post-exposure prophylaxis is a critical dimension of post-rape care, but it is just one dimension and a comprehensive care package needs to be delivered to all victims and should include support for the psychological responses to rape.

3. HIV prevention must embrace and incorporate promoting more gender equitable models of masculinity. Interventions that do this effectively must be promoted as part of HIV prevention.


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Women 'Naturally Weaker' to HIV. 14/07/09

Experts believe women are naturally programmed to be the weaker sex when it comes to fighting off HIV.

14 July 2009

It is well known that HIV progresses faster in women than in men with similar levels of HIV in the blood. Now a US research team has found that a receptor molecule involved in the first-line recognition of HIV responds differently in women. The findings in Nature Medicine might provide new ways to treat HIV and slow or stop the progression to Aids.

The Massachusetts General Hospital team explored whether known gender differences in the immune system might explain why HIV progresses faster in women.

They focused on immune cells called plasmacytoid dendritic cells or pDCs which are among the first cells to recognise and fight HIV.

Lab studies showed that a higher percentage of these cells from healthy, uninfected women became activated when presented with HIV-1 as compared with pDCs from healthy men.

Next they studied whether a woman's hormone levels might be involved.

Hormonal link

They found that pDCs from older women who had gone through the menopause had similar activity to that observed in men.

But premenopausal women with higher levels of the hormone progesterone had increased activation of pDCs in response to HIV-1.

Armed with this knowledge they then tested whether this increased activation of pDCs, in turn, led to activation of other immune cells called T cells.

When they tested the blood of men and women with HIV-1 they found the women did have higher levels of activated CD8-positive T cells than men with identical blood levels of HIV-1.

Lead researcher Dr Marcus Altfeld said: "While stronger activation of the immune system might be beneficial in the early stages of infection, resulting in lower levels of HIV-1 replication, persistent viral replication and stronger chronic immune activation can lead to the faster progression of Aids that has been seen in women."

Ultimately, drugs that work to modify this pathway might help patients with HIV, he said.

His team is beginning preliminary laboratory studies into this.

Jo Robinson from Terrence Higgins Trust said: "This is an interesting piece of research exploring whether HIV progresses faster in women than in men.

"Whilst there are some genetic differences based on sex, access to treatment remains the single most important factor in preventing HIV from progressing to Aids.

"Unfortunately women are most likely to be affected by the virus in places like sub-Saharan Africa, where they are also least likely to be able to access HIV treatment."

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Sterilised Without Consent. 21/06/09


-Jun 21 2009 06:00

Mail & Guardian

Women's rights activists have claimed that South African and Namibian public health doctors are making HIV-infected women infertile against their will.

South Africa's Woman's Legal Centre (WLC) has documented 12 cases of South African women, most of them HIV-infected, who claim to have undergone what the health world calls "coerced sterilisation".

Promise Mthembu, a Wits University researcher based in Durban, who is helping compile the cases, said coerced sterilisations were happening "in very large areas" of South Africa.

Mthembu said many of the patients were told that to gain access to medical services they had to undergo the procedure. She told of a 14-year-old Orange Farm resident who "went to get an abortion earlier this year, and they said they would only operate if she was sterilised".

Another documented case was that of a 19-year-old patient at Prince Mshiyeni Hospital, outside Durban. In 2007 she was allegedly pulled out of the delivery ward while in labour and told by the doctor that "you have to be sterilised".

"It comes down to the issue of informed consent," said Aziza Ahmed of the Washington DC office of the International Coalition of Women Living with HIV (ICW).

"If you don't understand what sterilisation means, or if the physician doesn't speak your language, that's not informed consent.

"You also can't really consent when you're in labour. If someone says to you 'sign these forms to have assistance with delivery', you're going to sign whatever's put in front of you."

South African health department spokesperson Fidel Hadibe said he could not comment on the claims.

In Namibia, the ICW is planning legal action against the government over alleged sterilisations. The group claims to have 40 confirmed cases, seven of which will be aired in court by the end of the year.

Ahmed argued that if pregnant women had improved access to programmes and drugs aimed at the prevention of mother-to-child transmission of HIV, such reproductive control would diminish. "The way new medicines work, there's a less than 2% chance of giving HIV to your child. Obviously we need to stop the spread of HIV to children, but [sterilisation] is not the correct way of looking at the issue." Prevention of mother to child transmission programmes in the region are underfunded, leaving millions of women without services.

Jennifer Gatsi-Mallet, the ICW's Namibian coordinator, said many of the women interviewed by the organisation "didn't know what sterilisation was. It was never explained to them; they thought it was part of a programme for women living with HIV."

Even after the procedure, most women did not fully understand what had happened. "One woman didn't even realise that she was sterilised until she went back to the doctor to get birth control," Mallet said.

The Namibian health ministry has not explicitly called for sterilisations, but the ICW claims that according to local doctors the issue was referred to in guidelines issued to all public health sites in the early 1990s, when HIV was beginning to hit the country.

The ICW said that despite repeated requests the ministry has refused to hand over old and current guidelines.

Priti Patel, a project lawyer with the HIV/Aids programme at the South African Litigation Centre, said the planned court action against the Namibian government was based on the country's Constitution.

"Sterilising a woman without her consent goes against fundamental concepts of people having the right over their own bodies," Patel said. "Part of being a human, and especially a woman, is the right to reproduce."

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HIV Positive Women Sterilized without Consent. 21/06/09

Lyn's CommentThe South Africa's Woman's Legal Centre (WLC) claims that they have records of at least 12 women who have had 'coerced' sterilizations in order to access health care.  Some of these were HIV positive.  It is claimed that in many cases the women did not understand what the procedure entailed.  This is not only unethical medical practice, but also a serious breach of human rights.

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The Truth About...Men, Boys And Sex: Gender Transformative Policies And Programming 13/6/09


The age of AIDS carries in its wake a renewed and belated recognition of the particular vulnerability of young women and girls through harmful gender norms and inequality. Yet all too often sexual and reproductive health and HIV programmes fail to engage men and boys to become better lovers, partners and fathers – for their own benefit, that of their partners and families and for changing gender stereotypes.
A new publication from the International Planned Parenthood Federation (IPPF), The Truth About...Men, Boys and Sex: Gender-transformative policies and programmes, focuses on this key element and provides information, evidence and practical advice on:
· Why working with men and boys is important;
· What SRH issues and services are particularly important for different men and boys; and
How programme developers, managers and service providers can integrate a focus on male sexual and reproductive health and gender transformation in their programming.
Featuring facts and figures, contributions from international experts and illustrative case studies, The Truth About...Men, Boys and Sex showcases best practice from across the world on the needs and rights of different groups of men and boys; including:
· Young men and boys
· Married men
· Men who have sex with men
· Men who inject drugs
· Male and transgender sex workers
· Men and boys living with HIV
As IPPF’s Director-General, Dr. Gill Greer, states out in her foreword “This unique combination of case studies and interviews…serves as a reminder that progress on the rights of women and girls is intimately linked to ensuring that men and boys are equal partners in this dialogue”
Download PDF 3.05 MB 
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Women Take Legal Action Over Alleged Sterilisations. 25/06/09


JOHANNESBURG, 25 June 2009 (PlusNews) - Two HIV-positive Namibian women who allege they were sterilised against their will in public hospitals are seeking redress through the courts, the first of more than 20 known cases, according to the International Community for Women Living with HIV/AIDS (ICW).

The ICW raised the alarm over what it terms forced or coerced sterilisations among HIV-positive women more than a year ago, after hearing accounts of it through its regular forums for HIV-positive young women.

The organisation has since partnered with the legal aid body, the Legal Assistance Centre (LAC), to bring two cases before a judge this year, according to the ICW's Aziza Ahmed.

lly go to trail this year, and a further 20 are being looked into by LAC and the ICW.

Although the ICW has been made aware of a number of other cases, legal action has been hampered by difficulties in collecting evidence and statements from women involved, who are often reluctant to come forward due to fears that both their HIV status and their inability to bear children will be made public, according to Veronica Kalambi, who sits on the ICW's southern Africa steering committee.

A matter of consent

Since the initial reports came to light, the ICW has conducted fact-finding missions to three of Namibia's 13 administrative regions to document stories from women who have been sterilised, some of whom said they signed consent forms to undergo what was simply listed on their health documents as a "BTL" without fully understanding its implications.

"BTL" is the acronym commonly used for bitubal ligations. Considered a permanent form of sterilisation, the procedure involves sealing a woman's fallopian tubes to prevent pregnancies. Reversals are possible but the procedure is costly and success is uncertain.

"The majority of these women are rural or illiterate, they don't know what 'BTL' means and there is no explanation. Even me, I didn't know what it meant," said Kalambi, adding that for some women, consent forms presented to them in English instead of their home languages were also a barrier to ensuring consent was actually informed.

The ICW's Saima Moses, who conducted research on the subject in northern Namibia, found some hospitals even had lists for women waiting to undergo the operation. Again, she said, few on the list had any idea what they were in for.

"It's a kind of discrimination," she said. "Nowadays, if you're HIV-positive, you can have a healthy child and it's your right [but] to doctors it's like because a woman is HIV-positive, why should they have a child? [Doctors] assume that child is always going to be sick."

According to Ahmed, a submission was made to the Deputy Minister of Health and Social Services (MoHSS) to investigate cases of alleged 'forced sterilisation', however she has yet to respond.

MoHSS spokesperson, Gladys Kamboo, told IRIN/PlusNews that the ministry declined to comment given the now legal nature of the issue.

In October 2008, IRIN/PlusNews spoke to Dr Rheinhardt Collin Gariseb, the head of Katatura State Hospital in the capital, Windhoek, where the ICW says sterilisations without informed consent have taken place.

Due process?
According to Gariseb, no incidents were reported to the hospital and that allegations were first brought to his attention through local media reports.

The hospital does offer tubal ligations to women, particularly those who may be on their third caesarean section and therefore have increased the possibility of their uteruses rupturing with another birth, but he maintained that if proper protocol was observed, there would be multiple opportunities for patients to object to an operation.

"It's the duty of the doctor to inform the patient through a translator, if necessary, [about any procedure]. Usually, we use one of the sisters, who takes the patient's consent," he said. "Then when the patient is taken to theatre, the sister hands over the patient to
the doctors and will again verify the procedure for which the patient has been admitted."

However, given the testimonials of women collected by the ICW complaining of the brusque attitude of some health workers, sisters doubling as translators could be cause for concern.

Shantel Ferreira* said she narrowly escaped being sterilised. The HIV-positive mother of two had checked into Katatura for what she assumed was a standard follow-up operation after she gave birth two months early.

Although she said she had asked what the BTL she was slated for was, an overworked nurse told her to sign and that she would tell her later. Eventually, after a power outage minutes before her operation was about to begin gave her the time she needed to find a nurse who, she said, took the time to explain the procedure's repercussions.

The LAC and IWC are still waiting for the trial dates for their first two cases. In the meantime, Kalambi said she has seen a worrying number of HIV-positive women express fears about delivering their babies at public hospitals due to the sterilisation scare.

That, she said, could have serious consequences for mothers and babies due to complications or lack of access to prevention of mother-to-child HIV transmission services.

*not her real name

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Real Men Don't Cry - or Do They. 06/05/09

RIO DE JANEIRO, 20 April (PLUSNEWS) - Men don't cry. Men take risks. Men don't ask for help. Men are strong. Men have many sexual partners. These stereotypes of masculinity are contributing to the spread of HIV throughout the world, experts warned at a recent symposium on men and boys.

"Among other things, these stereotypes affect access to health care, the expression of one's sexuality, access to sexual and reproductive health services, and vulnerability to HIV," said Purmina Mane, the adjunct executive director of the UN Population Fund (UNFPA) at the First Global Symposium Engaging Men and Boys in Achieving Gender Equality, held recently in Rio de Janeiro, Brazil.

Quoting various studies, Mane pointed out that among men high-risk behaviour was accepted and even encouraged, and most were more concerned about their masculinity than their health.

Studies have shown that among men knowledge about their health was lower than among women, and reproductive health was generally considered a women's subject.

Women talked about pregnancy, family planning, breast cancer and menopause, but never about sexual pleasure; men discussed sexual performance, sexual dysfunctions and sperm counts, but never contraceptive methods.

When this lack of knowledge is compounded by another macho stereotype - that seeking help is a sign of weakness - men's health is at far higher risk.

In the case of HIV, men are known to use counselling and voluntary testing services much less frequently than women, and men also tend to begin antiretroviral treatment later.

"Late diagnosis and treatment means that many continue to practice unprotected sex, running the risk of reinfection and of unknowingly infecting their partners," said Mane.

These stereotypes also have consequences for women. Dumisani Rebombo, a technical counsellor in South Africa to the international reproductive health organization, EngenderHealth, recalled a patient he had counselled after a positive diagnosis.

"I asked him what his next steps would be, and asked him to bring his wife to the support group. He said he wasn't going to reveal his status to his wife, nor was he going to use a condom, because he was a man and he'd find a way to deal with it."

The notion of a man's strength and invincibility was one of the main risk factors for HIV infection, he commented.

Selective perception

Graça Sambo, executive director of Fórum Mulher, an NGO working to promote women's rights, said the idea that men should have multiple sexual partners was contributing to Mozambique's national HIV prevalence of 16 percent, one of the highest in the world.

"A lot of men have many sexual partners because this is what is expected of them," she said. "Masculinity is very much instilled by culture and by tradition, which say that men have to be studs."

Sambo pointed out that although information about AIDS and the dangers of multiple relationships was widely available, if it involved a change in behaviour, men preferred to ignore it.

"We need men who think differently, and who can influence behaviour change ... Many of them are changing in the private sphere and acting in a more conscientious manner, but bringing this change into the public sphere is still very hard, because there is still a great deal of peer pressure and they fear being made fun of."

UNFPA's Mane concluded: "We need to redefine what it means to be a man. HIV is an opportunity to re-evaluate the rigidness of these norms."

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Changing 'Macho' Attitudes to Sex. 06/05/09

How can we change 'macho' attitudes to sex?


UN official argues that the idea that men should have multiple sexual partners and reject contraception is increasing exposure to the HIV virus for both men and women.

Speakers at the UN's first global symposium of men and boys in Rio de Janeiro this week have argued that macho stereotypes of what it takes to be a "real" man are helping spread HIV/Aids across the world.

Newswire IRIN is running an interview with Purmina Mane, an executive director of the UN Population Fund, who says the idea that men should have multiple sexual partners, take risks, are resilient to disease, reject contraception and be too strong to ask for help continue to affect access to healthcare and reproductive health services and is increasing exposure to the HIV virus for both men and women.

"Late diagnosis and treatment means that many continue to practice unprotected sex, running the risk of reinfection and of unknowingly infecting their partners," said Mane.

The story also quotes Graca Sambo, an executive director of Forum Mulher, a women's rights NGO in Mozambique, which said the idea that men should have many different sexual partners was a major contributing factor to the country having one of the highest HIV prevalence rates in the world – 16%.

"A lot of men have many sexual partners because this is what is expected of them," she said. "Masculinity is very much instilled by culture and by tradition, which say that men have to be studs."

The story reminded me of a conversation I had in February with Rose Ameso, a mother of four from Katine, who I met while she was waiting to get the results of her HIV test at the new Ojom diagnostic laboratory.

Rose told me that although her husband had been living away from the family while he was at police training school, he refused to get tested.

"Men don't like taking the test," she told me. "Many get sick and then they die because they try and do something about it, but by then it's too late." She said if she died of Aids there would be nobody to look after her four children. She also told me that many women found it difficult to ask their husbands to use condoms.

"Women ask and try to tell their husbands but they don't always agree because they don't think its natural," she said.

Rose's words were backed up by the lab technician at Ojom, who said many more women than men were coming to get tested at the lab.

"For men it can still be taboo," he said. "Many would rather not know."

For the first time in years Uganda's HIV prevalence rate is on the rise. Around 130,000 Ugandans are infected with the HIV virus every year and the government's new national HIV/Aids strategic plan bleakly predicts that the number of HIV-positive Ugandans will rise from 1.1 million in 2006 to 1.3 million in 2012.

The profile of HIV and Aids in Uganda is also changing. The most recent figures suggest that up to 65% of new HIV infections are now transmitted within marriage.

What was agreed at the conference in Rio was that there needs to be a massive cultural change to try to redefine what it means to be a man for millions across the world. The UN's Mane says he believes HIV could actually provide an opportunity to start breaking down rigid and culturally entrenched beliefs. But how can this be done, and how long will it take? Discussions at this conference indicate that men's attitudes have changed little over the past 20 years, despite high HIV/Aids prevalence rates and huge amounts of money spent on promoting safe sex. To change attitudes you need to start early. Will it take another generation before significant change is achieved?

Posted by Annie Kelly Thursday 23 April 2009 09.56 BST


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How Can We Change 'Macho' Attitudes to Sex? 23/04/09

The Guardian

UN official argues that the idea that men should have multiple sexual partners and reject contraception is increasing exposure to the HIV virus for both men and women

Speakers at the UN's first global symposium of men and boys in Rio de Janeiro this week have argued that macho stereotypes of what it takes to be a "real" man are helping spread HIV/Aids across the world.

Newswire IRIN is running an interview with Purmina Mane, an executive director of the UN Population Fund, who says the idea that men should have multiple sexual partners, take risks, are resilient to disease, reject contraception and be too strong to ask for help continue to affect access to healthcare and reproductive health services and is increasing exposure to the HIV virus for both men and women.

"Late diagnosis and treatment means that many continue to practice unprotected sex, running the risk of reinfection and of unknowingly infecting their partners," said Mane.

The story also quotes Graca Sambo, an executive director of Forum Mulher, a women's rights NGO in Mozambique, which said the idea that men should have many different sexual partners was a major contributing factor to the country having one of the highest HIV prevalence rates in the world – 16%.

"A lot of men have many sexual partners because this is what is expected of them," she said. "Masculinity is very much instilled by culture and by tradition, which say that men have to be studs."

The story reminded me of a conversation I had in February with Rose Ameso, a mother of four from Katine, who I met while she was waiting to get the results of her HIV test at the new Ojom diagnostic laboratory.

Rose told me that although her husband had been living away from the family while he was at police training school, he refused to get tested.

"Men don't like taking the test," she told me. "Many get sick and then they die because they try and do something about it, but by then it's too late." She said if she died of Aids there would be nobody to look after her four children. She also told me that many women found it difficult to ask their husbands to use condoms.

"Women ask and try to tell their husbands but they don't always agree because they don't think its natural," she said.

Rose's words were backed up by the lab technician at Ojom, who said many more women than men were coming to get tested at the lab.

"For men it can still be taboo," he said. "Many would rather not know."

For the first time in years Uganda's HIV prevalence rate is on the rise. Around 130,000 Ugandans are infected with the HIV virus every year and the government's new national HIV/Aids strategic plan bleakly predicts that the number of HIV-positive Ugandans will rise from 1.1 million in 2006 to 1.3 million in 2012.

The profile of HIV and Aids in Uganda is also changing. The most recent figures suggest that up to 65% of new HIV infections are now transmitted within marriage.

What was agreed at the conference in Rio was that there needs to be a massive cultural change to try to redefine what it means to be a man for millions across the world. The UN's Mane says he believes HIV could actually provide an opportunity to start breaking down rigid and culturally entrenched beliefs. But how can this be done, and how long will it take? Discussions at this conference indicate that men's attitudes have changed little over the past 20 years, despite high HIV/Aids prevalence rates and huge amounts of money spent on promoting safe sex. To change attitudes you need to start early. Will it take another generation before significant change is achieved?

Posted by Annie Kelly Thursday 23 April 2009 09.56 BST

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Women and HIV. 26/04/05

Text of a speech by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, delivered at the University of Pennsylvania's Summit on Global Issues in Women's Health, Philadelphia, April 26, 2005, 9:30 AM.

I well realize that this is a conference on women's global health, and everything I'm about to say will apply to that generic definition. But the more I thought of the subject matter, the more I want to use HIV/AIDS in Africa as a surrogate for every international issue of women's health, partly because it's what I know best; partly because it's an accurate reflection of reality.

I've been in the Envoy role for four years. Things are changing in an incremental, if painfully glacial way. It's now possible to feel merely catastrophic rather than apocalyptic. Initiatives on treatment, resources, training, capacity, infrastructure and prevention are underway. But one factor is largely impervious to change: the situation of women. On the ground, where it counts, where the wily words confront reality, the lives of women are as mercilessly desperate as they have always been in the last twenty plus years of the pandemic.

Just a few weeks ago, I was in Zambia, visiting a district well outside of Lusaka. We were taken to a rural village to see an "income generating project" run by a group of Women Living With AIDS. They were gathered under a large banner proclaiming their identity, some fifteen or twenty women, all living with the virus, all looking after orphans. They were standing proudly beside the income generating project a bountiful cabbage patch. After they had spoken volubly and eloquently about their needs and the needs of their children (as always, hunger led the litany), I asked about the cabbages. I assumed it supplemented their diet? Yes, they chorused. And you sell the surplus at market? An energetic nodding of heads. And I take it you make a profit? Yes again. What do you do with the profit? And this time there was an almost quizzical response as if to say what kind of ridiculous question is that surely you knew the answer before you asked: "We buy coffins of course; we never have enough coffins".

It's at moments like that when I feel the world has gone mad. That's no existential spasm on my part. I simply don't know how otherwise to characterize what we're doing to half of humankind.

I want to remind you that it took until the Bangkok AIDS conference in 2004 --- more than twenty years into the pandemic --- before the definitive report from UNAIDS disaggregated the statistics and commented, extensively, upon the devastating vulnerability of women. The phrase "AIDS has a woman's face" actually gained currency at the AIDS conference in Barcelona two years earlier, in 2002, and even then it was years late. Perhaps we should stop using it now as though it has a revelatory dimension. The women of Africa have always known whose face it is that's withered and aching from the virus.

I want to remind you that when the Millennium Development Goals were launched, there was no goal on sexual and reproductive health. How was that possible? Everyone is now scrambling to find a way to make sexual and reproductive health fit comfortably into HIV/AIDS or women's empowerment or maternal mortality. But it surely should have had a category, a goal, of its own. Interestingly, the primacy of women is rescued (albeit there's still no goal) in the Millennium Project document, authored by Jeffrey Sachs.

And while mentioning maternal mortality, allow me to point out that this issue has been haunting the lives of women for generations. I can remember back in the late 90s, when I was overseeing the publication of State of the World's Children for UNICEF, and we did a major piece on maternal mortality and realized that the same number of annual deaths --- between 500 and 600 hundred thousand --- had not changed for twenty years. And now it's thirty years. You can bet that if there was something called paternal mortality, the numbers wouldn't be frozen in time for three decades.

I want to remind you that within the UN system, there's something called the Task Force on Women and AIDS in Southern Africa. Permit me to tell you how it came about, and where it appears to be headed and I beg you to see this as descriptive rather than self-indulgent.

In January of 2003, I traveled with the Executive Director of the World Food Programme, James Morris, to four African countries beset by a combination of famine and AIDS: Zimbabwe, Zambia, Malawi and Lesotho. We had surmised, at the outset, that we would be dealing primarily with drought and erratic rainfall, but in the field it became apparent that to a devastating extent, agricultural productivity and household food security were being clobbered by AIDS. We were shocked by the human toll, the numbers of orphans, and the pervasive death amongst the female population. In fact, so distressed were we about the decimation of women, that we appealed to the Secretary-General of the United Nations to personally intervene.

And he did. He summoned a high level meeting on the 38th floor of the UN Secretariat, with TV conferencing outreach to James Morris in Rome and to the various UN agencies in Geneva, and after several agitated interventions, the Secretary-General struck a Task Force on Gender and AIDS in Southern Africa, to be chaired by Carol Bellamy of UNICEF.

If memory serves me, Carol Bellamy determined to focus on seven of the highest prevalence rate countries: studies were done, recommendations were made, costs of implementation were estimated, monographs were published. And here's what festers in the craw: the funding for implementation is not yet available. The needs and rights of women never command singular urgency.

There's an odd footnote to this. Within the last two months, a number of senior students at the University of Toronto Law School, compiled papers dealing with potential legal interventions on a number of issues related to HIV/AIDS in Africa. One of the issues was, predictably, gender. Not a single student, over the course of several weeks, whether on the internet or wider personal reading, came across the Secretary-General's Task Force (although one student said that she had a vague recollection that such a thing existed). The Task Force findings are clearly not something the UN promotes with messianic fervour.

I want to remind you that as recently as March, there was tabled, internationally, the Commission on Africa, chaired by Prime Minister Tony Blair indeed established by Tony Blair. It has received nothing but accolades, particularly for the analysis and recommendations on Official Development Assistance, on trade and on debt. The tributes are deserved. The document goes further down a progressive road than any other contemporary international compilation.

With one exception. I want it to be known --- because it's not known --- that the one aspect of this prestigious report which fails, lamentably, is the way in which it deals with women. There is the occasional obligatory paragraph which signals that the Commission recognizes that there are two sexes in the world, but by and large, given that women are absolutely central to the very integrity and survival of the African continent, they are dealt with as they are always dealt with in these auspicious studies: at the margins, in passing, pro forma. And it's not just HIV/AIDS; it's everything, from trade to agriculture to conflict to peace-building.

Maybe we should have guessed what was coming when there were only three women appointed out of seventeen commissioners. They had the whole world to choose from, and they could find only three women ... it doesn't even begin to meet the Beijing minimum target of thirty percent. We're not just climbing uphill; we might as well be facing the Himalayas.

I want to remind you, finally, of the arrangements we've made within the United Nations itself. HIV/AIDS is the worst plague this world is facing; it wrecks havoc on women and girls, and within the multilateral system, best-placed to confront the pandemic, we have absolutely no agency of power to promote women's development, to offer advice and technical assistance to governments on their behalf, and to oversee programmes, as well as representing the rights of women. We have no agency of authority to intervene on behalf of half the human race. Despite the mantra of 'Women's Rights are Human Rights', intoned at the International Conference on Human Rights in Vienna in 1993; despite the pugnacious assertion of the rights of women advanced at the Cairo International conference in 1994; despite the Beijing Conference on women in 1995; despite the existence of the Convention on the Elimination of Discrimination against Women, now ratified by over 150 countries; we have only UNIFEM, the UN Development Fund for Women, with an annual core budget in the vicinity of $20 million dollars, to represent the women of the world. There are several UNICEF offices in individual developing countries where the annual budget is greater than that of UNIFEM.

More, UNIFEM isn't even a free-standing entity. It's a department of the UNDP (the United Nations Development Programme). Its Executive Director ranks lower in grade than over a dozen of her colleagues within UNDP, and lower in rank than the vast majority of the Secretary-General's Special Representatives.

More still, because UNIFEM is so marginalized, there's nobody to represent women adequately on the group of co-sponsors convened by UNAIDS. You see, UNAIDS is a coordinating body: it coordinates the AIDS activities of UNICEF, UNDP, the World Bank, UNESCO, UNFPA, WHO, UNDCP (the Drug Agency), ILO and WFP. UNIFEM asked to be a co-sponsor, but it was denied that privilege.

So who, I ask, speaks for women at the heart of the pandemic? Well, UNFPA in part. And UNICEF, in part (a smaller part). And ostensibly UNDP (although from my observations in the field, "ostensible" is the operative word).

Let me be clear: what we have here is the most ferocious assault ever made by a communicable disease on women's health, and there is just no concerted coalition of forces to go to the barricades on women's behalf. We do have the Global Coalition on Women and AIDS, launched almost by way of desperation, by some international women leaders like Mary Robinson, like Geeta Rao Gupta, but they're struggling for significant sustainable funding, and their presence on the ground is inevitably peripheral.

I was listening to the presentations at the dinner last night, and thinking to myself, when in heaven's name does it end? Obstetric fistula causes such awful misery, and isn't it symptomatic that one of the largest --- perhaps the largest --- contributions to addressing this appalling condition has come not from a government but from Oprah Winfrey?

I was noting, just in the last 48 hours, that Save the Children in the UK has released a report pointing out that fully half of the three hundred thousand child soldiers in the world are girls. And if that isn't a maiming of health --- in this case emotional and psychological health --- then I don't know what is. And perhaps you notice the rancid irony: women have achieved parity on the receiving end of conflict and AIDS, but nowhere else.

Female genital mutilation, the contagion of violence against women, sexual violence in particular, rape as a weapon of war --- Rwanda, Darfur, Northern Uganda, Eastern Congo --- marital rape, child defilement, as it is called in Zambia, sexual trafficking, maternal mortality, early marriage‚.. I pause to point out that studies now show that in parts of Africa, the prevalence rates of HIV in marriage are often higher than they are for sexually active single women in the surrounding community; who would have thought that possible?‚

The overall subject matters you're tackling at this conference strike to the heart of the human condition. All my adult life I have accepted the feminist analysis of male power and authority. But perhaps because of an acute naivety, I never imagined that the analysis would be overwhelmed by the objective historical realities. Of course the women's movement has had great successes, but the contemporary global struggle to secure women's health seems to me to be a challenge of almost insuperable dimension.

And because I believe that, and because I see the evidence month after month, week after week, day after day, in the unremitting carnage of women and AIDS --- God it tears the heart from the body! I just don't know how to convey it! these young young women, who crave so desperately to live, who suddenly face a pox, a scourge which tears their life from them before they have a life, who can't even get treatment because the men are first in line, or the treatment rolls out at such a paralytic snail's pace, who are part of the 90% of pregnant women who have no access to the prevention of Mother to Child Transmission and so their infants are born positive, who carry the entire burden of care even while they're sick, tending to the family, carrying the water, tilling the fields, looking after the orphans, the women who lose their property, and have no inheritance rights, and no legal or jurisprudential infrastructure which will guarantee those rights, no criminal code which will stop the violence, because I have observed all of that, and have observed it for four years, and am driven to distraction by the recognition that it will continue, I want a kind of revolution in the world's response, not another stab at institutional reform, but a virtual revolution.

Let me, therefore, put before the conference, two quite pragmatic responses which will make a world of difference to women, and then a much more fundamental proposal.

Many at the conference will not know this, but the Kingdom of Swaziland recently made history when it received from the Global Fund on AIDS, Tuberculosis and Malaria, money to pay a stipend --- modest of course, but of huge impact --- to ten thousand caregivers, looking after orphans, the vast majority being women. The Swaziland National AIDS Commission (that may not be the precise name), reeling from the exploding orphan population, made the proposal for payment to the Global Fund, and it swept through the review process with nary a word. The amount is roughly $30/month, or a dollar a day, not a lot to be sure, but clearly enough to make a great difference.

My recommendation is that this conference orchestrate the writing of a letter, to be signed by people like Mary Robinson, Geeta Rao Gupta, and prominent women from academia, and have that letter sent to every African Head of State and Minister of Health, urging them to ask for compensation for caregivers, using the Swaziland precedent.

And the second pragmatic proposal? I would recommend, with every fibre of persuasion at my command, that the conference collaborate directly with the International Partnership on Microbicides, whose remarkably effective Executive Director, Dr. Zeda Rosenberg, will be here on campus on Thursday. She will tell you what she needs and how to go about getting it. The prospect of a microbicide, in the form of a gel or cream or ring, which will prevent infection, while permitting conception --- the partner need not even know of its presence --- can save the lives of millions of women. The head of UNAIDS, Dr. Peter Piot, who will be known to many of you, recently suggested that the discovery of a microbicide may be only three to four years off. That's almost miraculous: short of a vaccine --- and we must never stop the indefatigable hunt for a vaccine --- a microbicide can transform the lives of women, and dramatically reduce their disproportionate vulnerability. What's needed is science and money. You can help with both.

On the more fundamental front, I want to suggest that the process of UN reform, now urgently underway, be confronted with arguments that spare no impatience.

I have heard the President of Botswana use the word extermination when he described what the country is battling. I have heard the Prime Minister of Lesotho use the word annihilation when he described what the country is battling. I sat with the President of Zambia and members of his cabinet not long ago, when he used the word holocaust to describe what the country is battling.

The wor