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.

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.

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

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.

Breakthrough

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."

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.

AllAfrica

"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.

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

AIDSMap

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.

Implications

“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.

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

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.

Lesbian and Bisexual Women Vulnerable to HIV. 5/7/11

Misconception that these women are not at risk of contracting HIV.

Health-e

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.

Safe Sex Elusive for Many Women. 20/6/11

Most women still find it difficult to negotiate safe sex with their partners 

Health-e

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.

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.

Health-e

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.

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

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.

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

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.

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

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:

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.

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.

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.

Study Says Race, Gender and Geography Predict Poorer Health With HIV. 18/1/11

State of Health with HIV result of socioeconomic conditions

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.

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

AIDSMap

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.

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

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.

Conclusion

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.

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

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.

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.

AIDSMap

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:

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.”

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

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.

African Women's Decade Launched in Nairobi. 18/10/10

"Grassroots approach to gender equality and women's empowerment".

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

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.

Health-e

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. 

Africa: Women, the Silent Bearers of HIV Burdens. 29/7/10

When it comes to HIV, silence suffocates the women of Sub-Saharan Africa.

AllAfrica

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.

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From Training to Transformative Leadership 22/7/10

CEDPA

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).

Learn more about the initiative.

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

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.

UN Creates New Structure for Empowerment of Women. 2/7/10

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.

Health-e

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.

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

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.”

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.

AllAfrica

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

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

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.”

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.

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).

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.

"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:
http://ec.europa.eu/development/policies/crosscutting/genderequ_en.cfm

International Competition on Gender Equality
http://ec.europa.eu/europeaid/what/gender/drawing-competition_en.htm

Europe for Women
http://ec.europa.eu/publications/booklets/others/87/index_en.htm

Success stories of EU-funded projects:

Women Against Rape, Botswana
http://ec.europa.eu/europeaid/documents/case-studies/botswana_gender_war_en.pdf

Campaign for the eradication of violence against women and human trafficking in the state of Tlaxcala, Mexico
http://ec.europa.eu/europeaid/documents/case-studies/mexico_tlaxcala_en.pdf

Regional initiative for the equality of women in employment in Argentina, Colombia, Paraguay and Peru
http://ec.europa.eu/europeaid/documents/case-studies/latin-america_gender-equality_en.pdf

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 words are true; there's no hyperbole. The words apply, overwhelmingly, to women. That being the case, there has to be a proportionate response. It seems to me that the response should proceed on two simultaneous fronts.

First, let me say that I was thrilled by the suggestion from Mary Robinson, and others, that Penn State act as a kind of coordinator for the surprising numbers of initiatives, unrelated one to the other, occurring under the auspices of many universities. The practice of twinning, the practice of using various Faculties as training centres, the practice of American and Canadian universities bridging the gap in capacity until the developing country can take over, all of that is to the good, and it needs coordination. But there's more, I would submit, for you to do. Within multilateralism, that is within the UN system, wherein lies the best hope for leadership, there must be a change in the representation of women. There must emerge, for Women's Global Health, and certainly for HIV/AIDS, an agency, an organization, a powerful Think Tank, whatever the entity --- it can start on the outside, and then claim equal presence amongst the co-sponsors of UNAIDS, and thrust its advocacy upon the Secretariat, the Agencies, the member states, in unprecedented volume and urgency. Nor does this entity confine itself solely to women's global health, although that is the entry point. It insists on the 50% rule, just start your evidence-gathering by identifying the numbers of senior women, agency by agency, secretariat department by secretariat department, diplomatic mission by diplomatic mission, and when you've recovered from the shock of learning that the multilateral citadel knows nothing of affirmative action, then begin your unrelenting advocacy. This must become a movement for social change. It needs leadership. Why not this University, why not this conference? And let me emphasize; there's nothing limiting about this concept. We're looking towards the day when governments are finally made to understand that women constitute half of everything that affects humankind, and must therefore be engaged in absolutely everything. Why would it not be possible to build a movement, committed to the rights of women, in the first instance amongst nursing and medical faculties across the world, and take the world by storm? You have resources, knowledge and influence available to no others. The terrible problem is that you've never marshalled your collective capacities.

Second, a similar movement must be directed, I would submit, to Africa itself. I'm hesitant here, because there are enough neo-colonial impulses around without my being presumptuous in making recommendations for Africa, and indeed for women. But I must bring myself to say what I know to be true: the African leadership, at the highest level, is not engaged when it comes to women's health. There's so much lip service; there's so much patronizing gobble-de-gook. The political leadership of Africa has to be lobbied with an almost maniacal intensity on the issues of this conference, or nothing will change for women.

That, too, will take a monumental effort. In my fantasies, I see a group of African women, moving country to country, President to President, identifying violations of women's health specific to that country, and demanding a change so profound that it shakes to the root the gender relationships of the society. I know that African women leaders like Wangari Matthai and Gra‚§a Machel and many prominent cabinet ministers, committed activists and professionals think in those terms; what is needed is a massive outpouring of international support from their sisters and brothers on the planet.

I'm 67 years old. I'm a man. I've spent time in politics, diplomacy and multilateralism. I know a little of how this man's world works, but I still find much of it inexplicable. I don't really care anymore about whom I might offend or what line I cross: that's what's useful about inching into one's dotage.

I know only that this world is off its rocker when it comes to women. I must admit that I live in such a state of perpetual rage at what I see happening to women in the pandemic, that I would like to throttle those responsible, those who've waited so unendurably long to act, those who can find infinite resources for war but never sufficient resources to ameliorate the human condition.

I'm excited of course about the Millennium Development Goals, and I'm equally excited that with the leadership of the British, this next G8 Summit in the summer might just possibly spawn a breakthrough. And there are countless numbers of people working to that end.

But I have to say that I can't get the images of women I've met, unbearably ill, out of my mind. And I don't have it in me either to forgive or to forget. I have it in me only to join with all of you in the greatest liberation struggle there is: the struggle on behalf of the women of the world.

Stephen Lewis Foundation
Download from http://www.thebody.com/unaids/women_hiv_lewis.html?m95h

Brothers Are Doing It For Themselves. 8/10/09

Changing 'Macho' Attitudes to Sex. 06/05/09

How can we change 'macho' attitudes to sex?

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 guardian.co.uk

Defying Stereotypes: Men as Carers 04/03/09

Sonwabo Qathula puts on his apron and starts peeling a pile of butternuts, while a pot of rice boils on the stove next to him. The 50-year-old is preparing lunch for poor and orphaned children who attend a rural school in the Eastern Cape. When the meal is ready, he dishes out the food and serves it to the boys and girls. Later, he collects the empty plates and washes the dishes.

A man in the kitchen makes for an unusual sight in most places, urban or rural, in South Africa and is often accompanied by snide comments, mocking laughter or a shaking of heads in disapproval - from men as well as from women.

Patriarchy remains the widely accepted social norm and gender roles are clearly divided into how men are supposed to act and how women have to behave.Care giving - for children, the old or the ill - is generally regarded as a “woman’s job”. Men don’t cook, clean, get involved in the upbringing of their children or take care of the sick. They are seen as financial providers of their families and as the heads of households who lay the law. In one rural area in the Eastern Cape, however, all this has started to change.A group of nine men is working as home-based caregivers with the Siyakhanyisa HIV/AIDS  support group in Qumbu, 60 kilometres outside of Mthatha, to make a positive contribution to the welfare of their community. Initially ridiculed for doing work reserved for women, they have quickly become role models and earned respect for their courage to do things differently and take responsibility for the goings-on in their villages.

The men decided to get actively involved in helping others after they learnt about gender stereotypes, understandings of manhood and fatherhood during workshops run by NGO Sonke Gender Justice . They now care for people living with HIV, bathe the bedridden, counsel, educate about HIV prevention and transmission, facilitate access to anti-retroviral treatment, refer patients to social services and assist sick persons in writing their will.They also encourage community members to test for HIV, distribute condoms and help disadvantaged school children with their homework and cook for them.“In most places in South Africa, gender stereotypes are present and practised,” says Sonke Eastern Cape project manager Patrick Godana. “Men’s and women’s roles in society are divided, and as a result, men are often left out of community initiatives, particularly care and the upbringing of children.

Very few men spend time with their children and as a result most men can hardly relate to their children.”However, there is a steadily growing number of men who have shed stereotypical gender roles - only that many of them prefer to do this behind closed doors and with drawn curtains, says Sonke co-director Dean Peacock: “It’s not as bad as it seems. More men practise gender equality than we are aware of. But they do it quietly because they fear being ostracised and stigmatised. Gender discrimination is very powerful.”In South Africa, studies show that women still do 10 times more care work then men, says Peacock, but he is convinced that this imbalance is gradually shifting towards a more equal approach to caring and rearing. “It’s not a matter of black and white. Our realities are more complex. There are a few men that have become role models and practice gender equality. Not many, but they are there,” he explains.

Men’s involvement in care and child rearing is becoming increasingly important due to the high HIV and AIDS related mortality of women in South Africa. Households are without women, children are left without mothers - and the roles they have played remain unfilled. “That’s why it’s so critical that men, and especially fathers, get more actively involved,” says Peacock.Sonke taught men about gender roles in society, encouraged them to take a positive stand against gender-based violence, volunteer for HIV testing, take care of their own and their families’ health and play a more constructive role within their communities.Now, almost one third of Siyakhanyisa staff, which used to be an exclusively women-run organisation, is male - seven men work as caregivers for the NGO. “Since men got involved in home-based care, we have seen many benefits and a great change of social dynamics in our community. Our aim is to get a half men, half women team,” notes Siyakhanyisa project coordinator Siphokazi Makaula.

She says that, since the men have started to work as carers, there has been a growing demand for the organisation’s services, because most men in rural areas did not like to be cared for by women who are not family members but appreciate the help and support of men from the community. Makaula further says the numbers of people coming for voluntary counselling and testing (VCT) for HIV has increased and children, especially orphans, were better looked after.

“These men are a great example for other men,” she says.

Men caring for others is a relatively new phenomenon in South Africa and elsewhere on the continent. “In African society, it is seen as culturally incorrect to involve men in care. Men are seen as financial providers, while women are [supposed to be] the nurturers of the community,” explains Godana. “Men don’t even take care of their own health. Going to the clinic is regarded as a sign of weakness, of being ‘not man enough’.”Working on the premise that gender equality results in respect for each other which in turn creates a better society for all, Sonke’s work with men aims to change men’s, and women’s, mindsets around the roles people play within their communities.

“Care work, for example, is not seen as work that can earn a salary, so men think it’s a waste of time. This shows how difficult it is to be a woman in this country. Their work is considered worthless,” Godana says.That’s why it is “highly unusual” to have men working as caregivers, he further explains, “but the story of the men from Qumbu shows that men can change. It’s a break-through.”Men who were previously unemployed and had little to contribute to their families and communities have now become community leaders. “Initially, people were sceptical about men getting involved in care work, but when they saw the positive impact their involvement had on the community, they quickly changed their attitudes,” Godana adds.

The first man to go through Sonke gender training, join the Siyakhanyisa support group and become a caregiver was Qathula. A few years ago, the widower lost his wife to HIV-related illnesses, fell sick shortly thereafter and found out that he, like his wife, was HIV-positive after testing for the virus. He decided to seek help, became a member of the HIV and AIDS support group and soon saw an opportunity to not only be helped but help others as well.Today, Qathula publicly discloses his HIV status and educates others about the virus, the importance of testing and of positive living. For two years, he was the only man working with Siyakhanyisa, until, by positive example, he managed to convince six others to join the organisation in mid-2008.“[The training with] Sonke gave me the skills to talk to other men about health and gender,” he said. “I now know how to encourage others to think about ways in which we can create a better life for all of us.”Qathula says he initially received derogatory remarks from other men in his community who questioned his manhood because he was doing “women’s work”.

“It was not easy to take such comments, but I was never deterred,” he explained. “[After the gender training] I was comfortable enough within myself to challenge gender stereotypes and I got a lot of support from the rest of the home-based care team.”Now, Qathula, who says he used to be a “traditional” man who had not ever done housework in his entire life, does not hesitate to put on an apron to cook, wash dishes and help other women in the kitchen.

Over time, those who used to ridicule him have taken note of the positive impact of his work and started to show him respect. “People’s attitudes are changing. I get recognition from the school principal, the chief of my area and many men and women in my community,” says Qathula. “Being able to help people makes me proud and that’s what keeps me going.”His sentiments are echoed by Mzolisi Nyembezi (31), another of the seven men who work as caregivers for Siyakhanyisa. Nyembezi says he initially doubted care work was for him: “At first, I didn’t see why a man has to do this type of work. I also got many derogatory comments. People said I was doing women’s work and laughed at me.”But after attending Sonke’s One Man Can training and talking to Qathula, Nyembezi changed his mind and saw value in caring for others. “I had just been released from jail and for the first time in my life, I learnt about gender and fatherhood. I always thought it was women’s responsibility to take care of children and that men are only sperm donors.”Nyembezi, who has an eight-year-old son, started to play an active role in his child’s life. “I don’t just give money. I nurture him, give him life skills, show interest in his education,” he says. He also changed his attitude about manhood and his relationship to women.

Before being incarcerated, Nyembezi says he used to come home drunk and physically abuse his sister. “I thought this was my right. I understood only now that it’s not cool to abuse; that I have two healthy hands, so I don’t need women to serve me.”“He realised that what he had done was wrong. He apologised to his sister and started to respect the women in his life,” adds Godana.Nyembezi says he was elated about his new way of life and decided to share his knowledge with others. When caring for ill men, he started to talk to them about gender issues. He also got involved in community outreach focused on gender and AIDS education. Nyembezi and his fellow male caregivers hand out condoms at local taxi ranks and use this opportunity to speak to men about gender roles, manhood, fidelity and HIV prevention and urge them to get tested for HIV.That’s where Nyembezi met Andile Ngamlana who found out that he is HIV-positive after he suffered from long-term respiratory problems. Ngamlana’s girlfriend, who was at that time pregnant with his child, urged him to visit the local health centre and both tested for HIV.

“I was [HIV] positive, my girlfriend tested [HIV] negative, but she stuck with me despite the virus and that was a motivation for me,” says Ngamlana.The 25-year-old joined the Siyakhanyisa support group and soon trained as a caregiver. “Initially I was a bit afraid because, as a young man, you don’t want to be associated with the virus,” he explains. “But then I decided to tell the world that I am positive. That I am living with the virus, but am helping others who are ill.”Ngamlana also attended One Man Can gender training sessions facilitated by Sonke and says the workshops helped him to improve his relationship with his girlfriend. “I learnt better ways of relating to her, to consult, communicate and make decisions together,” he explains. “I don’t solve conflict with anger and violence anymore, but show love to my girlfriend and daughter. I nurture them.”

He says the training sessions changed his understanding of what it means to have a trusting and stable relationship. “I am now aware of the importance of being faithful. Before, I equated love with sex. Now I know that love goes beyond that, that there is more to it than just sex.”

Apart from working as a home-based carer, Ngamlana, like Qathula and Nyembezi, assists orphaned and poor children with their homework and cooks them a meal every day after school. “In the beginning, I didn’t know a thing about cooking. I am a man, so cooking was never my responsibility,” he says. Today, he is proud of the role he plays at the local school and the respect and admiration he gets from the children.This, he says, helps him to cope with the peer pressure he feels from other young adults in his community who think it is not “cool” for a man like Ngamlana to “behave like a woman”. The acknowledgement from those he cares for also helps him to handle the hurtful rejection he experienced when he disclosed his HIV status to his older brother, who lives in Johannesburg and ceased contact with Ngamlana when he heard his brother was infected with the virus.

Together with Qathula and Nyembezi, Ngamlana stands by the sink and discusses the progress each child has made in its homework and what to cook the next day. At the end of the afternoon, they take off their aprons and contently walk home, with smiles on their faces.

Kristin Palitza is a is a freelance journalist, editor, media consultant and trainer. This article was written for Sonke Gender Justice.

Feminization of AIDS, Gender Inequality. 14/03/07

Catholic Online

In a March 13 lecture, “The Female Face of HIV and AIDS, Jesuit Father Michael J. Kelly pointed to the steady global increase in the numbers and proportions of women and girls infected, the doubling of the number of people living with HIV or AIDS * from about 20 million in 1996 to almost 40 million in 2006 * and the inadequacy of leadership and the low sense of urgency of current prevention and treatment programs.

“No response to the AIDS epidemic will succeed until specific, strong action is taken eliminate the prejudice, discrimination and unequal treatment that women experience,” said the former professor of education at the University of Zambia, at the annual Lenten lecture of Trocaire, the official overseas development agency of the Catholic Church in Ireland.

“Without a frontal attack on the injustice of gender inequality * in church, state, and every walk of life * the dominance of the epidemic will continue,” he said, noting that Pope Benedict XVI highlighted “persistent inequalities between men and women” and “exploitation of women” in his 2007 World Day of Peace message.

He sketched for those gathered at St. Patrick’s College here the contours of the female face of the epidemic and poverty, noting that “globally, and in every region of the world, more adult women than ever before are living with HIV infection,” with 17.7 million so afflicted.

The global HIV-AIDS epidemic claims the lives of more than five lives each minute of every day, grows with the addition of 500 new infections every hour and leads to millions of children being orphaned, Father Kelly said.

“It leaves in its wake millions of men, women and children, experiencing a heartbreaking mixture of fear and anxiety, bodily pain and physical disability, isolation and rejection, loneliness and depression, anger and guilt,” he said.

“In every severely affected country, the epidemic continues to: reverse decades of health, economic and social progress; reduce life expectancy; slow economic growth; deepen poverty; contribute to and exacerbate food shortages; create a growing human capacity crisis; and augment gender inequalities by affecting women and girls more than men and boys,” he added.

The feminization of the AIDS crisis is worsened by “extensive stigma and discrimination and by silence and denial at national, community and individual levels,” Father Kelly stressed.

The “underground silence, secrecy, shame and self-recrimination” tied to global AIDS-related health efforts focused primarily on short-term measures aimed at immediate results ultimately prevent dealing with the root causes of the epidemic’s growth, he said.

“The environment of poverty, malnutrition, the powerlessness in many societies of women and young girls, inadequate health support services, lack of job opportunities and the absence of recreational outlets,” he said, all “provide fertile ground for the transmission and development of the disease.”

He added that there has been “insufficient attention” to the needs of youth. “The AIDS epidemic will only be reversed when it is reversed among the youth * no sooner, no later,” he said.

“Like a very powerful spotlight, the epidemic reveals this weakness in almost all societies where a legacy of systematic discrimination against women is embedded in economic, social, political, religious and linguistic structures,” the Jesuit priest said. “The central HIV issue is not technological, biological, behavioural or sexual. It is the inferior status or role of women.”

While the Catholic Church “has played a significant service role” in reaching out to orphans and in providing one-third of global AIDS care, more is needed to be done, Father Kelly said,

“The female face of the epidemic is a real challenge to it to do so,” he said.

The Catholic Church must move away from its own discrimination and gender stereotypes toward women and promote their “active empowerment” within it and in society, he said.

“Because our mother the church herself has AIDS, because our sisters are carrying the brunt of the epidemic and at the same time providing the most significant response,” Father Kelly said, “HIV and AIDS challenge the entire church to move more boldly towards affirming the participation and contribution of women.”

He stressed that “the feminization of AIDS calls for the feminization of ecclesial identity, with an equal role for women in the exercise of ministry, authority and decision-making.”

This time of AIDS, while being “a moment of monumental human suffering and anguish,” is “a moment of special grace, a unique kairos moment when God calls us to move from our set ways and be converted personally and structurally,” he said.

The “vicious assault” of AIDS must compel the church to act, the priest said.

Hastening the day when full equality between women and men will be recognized will “also hasten the day when the stranglehold of HIV and AIDS will be loosened so that men, women and their children can experience a life of dignity and fulfilment,” Father Kelly concluded.

During the evening lecture event, Trócaire launched its annual Development Review, which this year focused on the issue of gender equality and development.

In its comprehensive analysis of global gender inequality, the 2007 review calls for moving gender equality to the top of the development agenda. It asks why, despite so much effort and extensive public commitment to gender equality, have real progress and actual achievement been minimal and why, with major advances in many parts of the world, women continue to suffer oppression and inequality.

“This year’s Trócaire Development Review and its coverage of gender is very timely,” said Justin Kilcullen, Trócaire director. “As new development challenges, such as climate change, rightly take on greater significance in the media, it is vital that we keep our attention on other enduring inequalities which do not grab newspaper headlines in the same way. The persistent inequality between women and men throughout the world is the most obvious and prevalent manifestation of such injustice.”

For more than 20 years Trócaire’s Development Review has drawn together policy analysis and research findings from academics and its staff, mapping Ireland’s evolving role in international development with particular focus on the impact of Ireland and the European Union policies on the developing world.

HIV Positive Women Sterilized without Consent. 21/06/09

Lyn's Comment:  The 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.

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 guardian.co.uk

It Takes More Than a Law to Stop the Cut. 05/01/09

A law passed in November 2008 prohibiting female genital mutilation/cutting (FGM/C) in the state of Southern Kordofan is unique in Sudan. But for it to translate into genuine abolition, deep-seated attitudes and misinformation will have to be overcome.

More than two-thirds of women in the state have undergone FGM/C, according to a 2006 household survey conducted by the Ministry of Health.

"All my daughters have been circumcised," Asia Abdalla Jibril, a tea-seller, told IRIN in Kadugli, the state capital.

"The clitoris is dirty. If you undergo FGM you become clean," Jibril said. In Sudan, the Arabic word “tahur”, which means purity, is often used for FGM/C.

"If a baby is sick, FGM helps,” added Jibril. “For example if a baby has duda [fever] and weight loss, the cut helps the child to grow better and gain weight." Most girls undergo FGM/C at about six years old in the state.

This attitude is not unusual. “Women affected by genital mutilation do not uniformly regard it as mutilation, and may react negatively to being referred to as ‘damaged’,” according to a report on FGM/C in Sudan and Somalia compiled by Norway’s Country of Origin Information Centre in December 2008.

This is despite the fact, the report stated, that “the procedure is mainly carried out by so-called excisors or circumcisers with no medical qualifications. Girls who do not experience chronic pain, serious bleeding or blood poisoning after the procedure often suffer complications during pregnancy, experience great pain during sexual intercourse, and suffer other gynaeocological problems and traumas later in life.”

Common FGM/C types in the state – and elsewhere in Sudan - are the Pharaonic and Sunna forms. The former, also known as infibulation, involves the total removal of all external sex organs before the vagina is sewn up, leaving a small opening for the passing of menstrual blood, while the Sunna type is less extensive.

Childbirth in Sudan is frequently followed by reinfibulation, even though the original procedure caused problems during delivery. One of the main reasons cited for this “re-tightening” is to increase a husband’s pleasure.

Although she knew FGM/C was now banned, Jibril said she believed some form was still necessary. "The Pharaonic one was bad but the Sunna type is better," she said. "It should continue."

Advocacy
"It is mainly the 'grandmothers' who still want FGM," said Wahid Eldeen Abed Elrahim, director of the National Council for Child Welfare, an NGO working to monitor and encourage implementation of the Convention on the Rights of the Child.

More educated men are being convinced that they should protect their children, Elrahim said, adding that it had taken 18 months of advocacy and awareness-creation before the mainly male-dominated legislative council in the state passed the FGM/C Law.

Under the new legislation, the penalty for an FGM/C offence will be 10 years’ imprisonment and compensation to the family if it caused the death of the victim. The attempt, assisting in the procedure and abetment will be penalised with two-year jail terms. Those propagating FGM/C and operating places where it is committed will also be punished and repeat offenders imprisoned for life.

In addition, information about protection against FGM/C will be issued at the birth of every girl and incorporated into school curricula.

A national strategy was launched in Sudan in 2008, with the aim of total abolition and zero tolerance within 10 years.

Elrahim said there was a long way to go. "Families are worried that their girls will not get married if they are not circumcised," he said.

"I think it is time for the children to be allowed to decide whether or not to undergo FGM/C. But even then most will still opt for FGM/C just before marriage," said Zainab Kordofor, a Kadugli resident.

The focus now is on creating awareness, especially among influential communities such as those in Al Fula, in the west, where the practice is particularly prevalent, to mobilise support for the collective abandonment of FGM/C.

"We are focusing on ensuring that the high-profile areas are aware of the FGM act and of the punishment for engaging in the practice," said Huda Gamar Hussien, a social worker.

"The passing of the law will, however, not change behaviour overnight," said Hussien. "Right now we are seeing movement from the Pharaonic type to Sunna, then maybe later to no FGM at all."

Launch of ‘10 Reasons Why Criminalization of HIV Exposure or Transmission Harms Women’. 1/12/09

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 admin@athenanetwork.org.

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Lovers, Fathers And Brothers 26/8/09

 PLUSNEWS

Men Should Be More Active in Home-Based HIV Care 6/03/2009

Men need to take on a greater role in caring for people living with HIV, said U.N. Deputy Secretary-General Asha–Rose Migiro as reported by PlusNews. At the 53rd session of the U.N. Commission on the Status of Women, Migiro said that if men helped out more in HIV care-giving and other domestic tasks, they would have a greater role in the lives of their families.

“We must address the significant responsibilities faced by women and girls during home-based care in the context of HIV and AIDS and find ways to strengthen the role of men,” Migiro said. “We must also develop innovative ways to eliminate gender stereotypes about the roles of women and men beginning at an early age in homes, schools and communities and engaging leaders in all walks of life.”

According to the article, she added that laws to promote equal responsibility should include closing the gap in pay, increasing flexibility in working arrangements and instituting better leave provisions for both women and men.

MenEngage Africa Explores Masculinities. 4/11/09

Migiro Calls for More Rights for Women in HIV/AIDS Care-giving. 02/03/2009

UN 2 March 2009 –

Too many women shoulder the heaviest burden in caring for people living with HIV and AIDS, Deputy Secretary-General Asha-Rose Migiro said today, calling for greater balance in responsibilities between men and women.

This inequality “is unjust and a serious form of discrimination, even a form of violence” against women, she said in remarks in New York at the opening of the 53rd session of the Commission on the Status of Women.

Women are restricted in employment, education and public life, while men are held back from taking part in their families’ lives, she said. “Families, communities and society as a whole suffer the consequences.”

The HIV and AIDS pandemic has highlighted the need for a comprehensive approach, involving all members of society, to address this imbalance, Ms. Migiro emphasized.

She noted several steps that must be taken, including recognizing unpaid work and caregiving at the home and community level, as well as easing the burden of domestic and care responsibilities.

Further, the Deputy Secretary-General called for legislation and policies such as closing the pay gap between men and women and stepping up flexible work arrangements.

“Ensuring that caregivers have the means to do their work effectively has a cost that society must be ready to meet,” she underscored. “We must provide adequate resources to empower women and girls who are dedicating their time to looking after people living with HIV.”

Eliminating inequalities must be a priority, in spite of the challenges posed by the current global and economic crises that are thwarting progress in achieving the Millennium Development Goals (MDGs), eight internationally agreed targets, including the eradication of poverty and gender inequality, with a 2015 deadline.

This session of the CSW will discuss the issue of unequal sharing of responsibilities between men and women in HIV/AIDS caregiving contexts through high-level roundtables and expert panels. UN agencies, permanent missions to the world body and non-governmental organizations (NGOs) will host numerous parallel events during the two-week session.

In a related development, the UN Educational, Scientific and Cultural Organization (UNESCO) and the cosmetics company L’Oréal announced the names of the 15 promising young women post-doctoral researchers selected for fellowships as part of their efforts to foster global scientific cooperation.

The two-year fellowships will allow these scientists to pursue research outside their home countries.

In addition, the L’Oréal-UNESCO Awards For Women in Science – which seek to change the face of science and support the advancement of women in the scientific field – recognized five outstanding women researchers from five continents in recognition of their work in physical sciences.

Nominated by a network of almost 1,000 scientists worldwide, this year’s laureates were selected by an international jury comprising 17 leading scientists, presided over by Ahmed Zewail, winner of the 1999 Nobel Prize in Chemistry.

Since its launch in 1998, more than 500 women researchers around the world have benefited from the L’Oréal and UNESCO’s joint “Women in Science” programme. Nearly 140 international and over 400 national fellowships have been awarded, while 57 women scientists have received L’Oréal-UNESCO Awards so far.

Need for Female-biased Prevention. 07/08/08

A key feature of South Africa’s HIV epidemic where 5.7 million people are positive is that among the 15 – 24 year olds infected, women and girls account for more than 90% of new infections. This needs a special focus on this group when designing prevention programmes, says UNAIDS.

The HIV/AIDS epidemic in South Africa is stabilising, according to a report released last week by the Joint United Nations’ Programme on HIV/AIDS. This means that there has not been a recognisable increase in the rate of new infections over the last few years. Instead, the infection rate has remained relatively constant. This, however, does not mean that the epidemic is declining as the country still holds the unenviable world’s number one position in the stakes of the total number of people living with HIV. The fact that women and girls continue to be disproportionately infected points to a failure of HIV programmes in addressing the issues that place females at risk of HIV infection, says the United Nations’ Special Envoy on AIDS in Africa, Elizabeth Mataka.   

“I think time has come for us to be bold and attack and question some of those cultural norms and practices that drive this epidemic and make women more vulnerable to infection - the issues of inter-generational sex, for example; issues of tolerance of male promiscuity, for example”, she declared.

Mark Stirling, Director of the Joint United Nations’ Programme on HIV/AIDS (UNAIDS), in east and southern Africa, agreed and added that there is an urgent need to  reverse the pattern of HIV infection in women and girls. 

“The changing of that vulnerability to HIV infection requires targeting of young women, but also requires targeting of older men. And that requires a questioning of social norms which allow older men to maintain sexual relationships with young women”, he said.

This must be done as a matter of urgency despite news from UNAIDS last week that the country’s epidemic is stabilising.

“This is not the time for complacency… The challenges are there. We need to keep on talking about them. We need to recognise them and we need to continue to find new ways of dealing with those challenges,” said special envoy Elizabeth Mataka.

New Approaches for Women Needed 22/10/08

Citing concerns that the ABC prevention method -- which stands for Abstinence, Be faithful and use Condoms -- does not provide women with sufficient protection against HIV/AIDS because of issues such as rape, early marriage and low condom use, advocates for women's reproductive health recently called for new approaches to reducing the disease among women, Ghana's Public Agenda reports. According to the Public Agenda, the ABC method is not considered a pragmatic option for millions of women and girls in Africa who often are taught to obey men.

Bernice Heloo, president of the Society for Women and AIDS in Africa who spoke at a workshop aimed at providing the media and women with skills to address HIV/AIDS, said that more women are contracting HIV because of several factors, including gender inequality. "Women are already marginalized, and HIV and AIDS have worsened their plight," Heloo said, adding, "It is very difficult for them to negotiate condom use." She also said that although the emergence of antiretroviral drugs has made significant gains in HIV/AIDS prevention, many people living with the disease, particularly women, do not have access to the drugs or cannot buy them.

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

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."

New UN Database on Violence Against Women. 5/3/09

UN

Poor Scorecards On AIDS Responses For Women. 25/11/09

Press Statement on behalf of Sonke Gender Justice Network and People Opposed to Women Abuse (POWA) - 11/03/2009

11 March, 2009  NGO Pulse

The 53rd session of the annual United Nations Commission on the Status of Women is focused on the theme “The equal sharing of responsibilities between women and men, including caregiving in the context of HIV and AIDS”.

The meeting provides a critical opportunity for governments and civil society to generate proposals that might address the enormous and debilitating physical and emotional burden of care borne by women and girls across the world, including especially in countries which are hard hit by HIV and AIDS, like South Africa.

South Africa’s 2007-2011 National Strategic Plan on HIV and AIDS includes mention of many important strategies to reduce the total burden by increasing access to effective prevention and treatment and alleviating the burden of care by increasing the numbers of male care givers. The NSP is widely recognised as international best practice and did much to restore South Africa’s reputation in the international community after years of AIDS denialism within the Presidency and the Department of Health.

The NSP sets clear and ambitious prevention and treatment goals aimed at reducing the care burden. The NSP commits government to 1) “reducing the number of new HIV infections by 50% and 2) reducing “HIV and AIDS morbidity and mortality as well as its socioeconomic impacts by providing appropriate packages of treatment, care and support to 80% of HIV positive people and their families by 2011”. In addition, it resolves to “improve quality of life for children and adults with HIV and AIDS requiring terminal care and strengthen the health system and remove barriers to access”.

The NSP also includes explicit goals to increase men’s active participation in the provision of home and community based care and resolves to “recruit and train new community care givers, with emphasis on men”, and sets a numeric target of increasing men’s involvement by 20% by 2011.

Despite the ambitious targets set in the NSP, prevention and treatment efforts lag far behind schedule. According to reports released by the South African National AIDS Council “there has been an 87% rise in the number of deaths reported between 1997 and 2005 and deaths among those aged 25-49 has risen by 169%, surging from contributing 30% of all deaths in 1997 to 42% by 2005. This can only be explained by the HIV epidemic.” The document also reports that only 28 percent of people who need access to treatment currently have it and this, the report points out, is “below the global average for low- and middle-income countries”.”

The UN CSW offers an opportunity for South Africa to work with UN agencies, civil society and other UN signatory countries to seek bold solutions to prevention and treatment efforts and thereby reducing the burden of AIDS related care.

Sadly, the pronouncements made on behalf of the South African government delegation to the 2009 UN CSW by Manto Tshabalala Msimang, the former Minister of Health and now the Minister in the Presidency, have once again undermined South Africa’s credibility in the international community and stand in stark contradiction to the priorities laid out in the NSP.

The issues raised in her various presentations undermine the consensus government and civil society reached in the National Strategic Plan on HIV and AIDS. Minister Tshabalala-Msimang’s repeated statements at CSW calling for additional research on alternative and traditional remedies and for “pharmacovigilance” and drug surveillance distract from the important issues being discussed at the CSW and represent a lost opportunity to focus on the key issues in the NSP related to the care economy.

When senior government representatives imply that anti-retroviral therapies are not safe they sow confusion and compromise our efforts to ensure that people access and adhere to treatment. When they do this, they contribute to illness and death and compound the burden of care carried by women and girls. The goal of this year’s CSW is to reduce the burden of care on women. As they have on many occasions in the past, Minister Tshabalala Msimang’s comments threaten to undermine this goal and to once again undermine the credibility of the South African government’s commitment to addressing HIV and AIDS.

We call on the South African government to clarify its position on treatment roll-out and explain why a senior representative of the government continues to focus on drug safety even though the NSP makes it clear that this is not an issue of contention, saying “Great emphasis has been placed on ensuring that new drugs are safe - both in the mainstream and traditional health sectors.”

We also call on government to ensure that all efforts are made to ensure access to treatment in the Free State where stock-outs continue to cost people their lives.

The minister of health should be strengthened in her efforts to advance the NSP and to deliver on the clear commitments it has made.

We further encourage the government to translate into action the agreed upon conclusions arrived at the 2009 CSW session in line with the 20070-2011 National Strategic Plan paying particular attention to the following three priority areas:
1) strengthening the capacity of the health sector;
2) implementing effective HIV prevention and treatment strategies and
3) implementing the various strategies South Africa has committed to increase the involvement of men and boys in achieving gender equality, including full participation in AIDS related home and community based care.

Protecting Mothers, Sisters & Partners From HIV 5/9/09

 Health-e

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."

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:

Sharing Responsibility For Giving Care - 9/03/09

AJANews 78 - April 2009

Archbishop Celestino Migliore, Permanent Observer of the Holy See to the UN Economic and Social Council, made the following statement on men and women sharing responsibilities during the 53rd session of the Commission on the Status of Women in New York on 9 March 2009.

Mr Chairman,
My delegation applauds the choice of such an important and timely topic for this discussion: the equal sharing of responsibilities between women and men, including care-giving in the context of HIV/AIDS.

To consider care as a fundamental aspect of human life has profound implications.
Care-giving involves programmes, policies and budgetary decisions, as well as personal attitude and commitment for the wellbeing of others. The interrelatedness between activity and personal attitude is self-evident but not always to be presupposed.

Human beings are not only autonomous and equal but also interdependent creatures who, regardless of their social status and stage of life, may need care.

Focusing on care and sharing responsibility between women and men in coping with pressing issues such as prevention and treatment of HIV/AIDS, child-rearing, housework and support for older family members, leads us to think of the relationship between man and woman in society as interdependent. 

The overcoming of the dilemma between autonomy and dependence also favours a new vision of the work of care that can no longer be attributed only to certain groups, such as women and immigrants, but must also be shared between all women and men, in households as well as in the public sector.

In particular, it is more and more untenable that there continue to be attitudes and places - even in health care - where women are discriminated against and their contribution to society is undervalued simply because they are women. Recourse to social and cultural pressure in order to maintain the inequality of the sexes is unacceptable.

Mr Chairman, since our debate mainly focuses on sharing responsibilities and care-giving between women and men in the context of HIV/AIDS, the very first thought goes to the primary and best meaning of care, namely taking care, protecting and promoting the wellbeing of others. In this context, HIV/AIDS calls into question the values by which we live our lives and how we treat, or fail to treat, one another.

Community-based care and worldwide support for those suffering from this disease remain essential. Home-based care is the preferred means of care in many social and cultural settings, and is often more sustainable and successful over the long term when based within communities. In fact, when many members of a community are involved in care and support, there is less likely to be stigma associated with the disease.

Unfortunately, community- and home-based care is largely unrecognized, and many caregivers face precarious financial situations. Very little of the funds spent every year on providing assistance to those who are suffering as well as on much needed research to combat the disease goes to supporting them. Studies have shown that community- and home-based caregivers actually experience more stress than medical personnel; so better support must be provided for these persons, particularly women and older persons who are caregivers.

My delegation would also like to focus on some aspects of the globalization of care-giving which are affecting in particular poor and immigrant women. In societies characterized by important demographic transformations, familial and occupational and inadequate welfare systems, immigrant women respond to the demand to care for children, the sick, severely disabled people and the elderly. In many parts of the world, a true market has emerged in the area of home-based care-giving, in which women above all are found in situations of vulnerability due to non-regularization, social isolation, difficult working conditions and at times exploitation of every kind.

Governments should properly recognize that the budget and organization of public institutions are somewhat relieved by family-based care-giving and should thus adopt migration laws aimed at creating social integration and full protection of immigrant caregivers and fostering social integration. Likewise, supporting an appropriate professional formation that offers to home-based care-givers basic knowledge of health and psychology would upgrade their invaluable activity and eventually shield them from easy and reprehensible types of exploitation.

Developing countries are suffering from brain drain, as many of their educated, talented and skilled human capital - especially in the health sector - leave their places for better economic opportunities in rich countries. Market-forces get the blame for this, but this is an area where countries of origin, transit and destination need to work together to help developing countries retain, or at least readmit, these skilled members of their workforce, providing suitable incentives to recognize and better remunerate them so that caregivers may more easily be able to stay at home.

Finally, Mr Chairman, too many cultures hold that care is to be restricted to the private sphere and presupposes that it is provided in the domestic realm.

Care in itself must become a topic of public debate and take on an importance capable of shaping political life and giving men and women the ability to be more concerned for the needs of others, more empathetic and able to focus on others.

Care, in this sense, has the capacity to create a process of democratization of society and to foster a public awareness aimed at social and effective justice and solidarity for all women and men.

AJANews is published by the African Jesuit AIDS Network (AJAN) in English, French and Portuguese and is available free of charge. To subscribe, or to change your e-mail address, please click on Update Profile/Email Address below or write to ajanews@jesuitaids.net.

The Equality Courts As A Tool For Gender Transformation. 8/9/09

 NGO Pulse  

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

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.

The Truth About...Men, Boys And Sex: Gender Transformative Policies And Programming 13/6/09

aidsportal

Throwing the book at AIDS. 25/01/07

AFRICA: Throwing the book at AIDS

[This report does not necessarily reflect the views of the United Nations]

NAIROBI, 25 January (PLUSNEWS) - What AIDS prevention method lasts a lifetime and is particularly effective among young women? Education, delegates attending the World Social Forum [http://wsf2007.org/] in the Kenyan capital, Nairobi, heard this week.

In parts of sub-Saharan Africa and the Caribbean, young women are up to six times more likely to be infected with HIV than their male counterparts. That has a lot to do with the imbalance of power between the sexes, according to Charles Abani, regional operations manager for Africa with the anti-poverty NGO, ActionAid.

Women and girls are generally more vulnerable because lower levels of education and financial autonomy make them more dependent on men.

"There is great potential in HIV control through education; mainly girls' education," he said. "Education delays sexual debut, meaning that girls are able to make more informed choices."

According a 2006 ActionAid report, 'Girl Power', HIV prevalence declines among people with higher education levels. In Tanzania, girls with upper secondary education were seven times less likely to be HIV infected; in Uganda, those with primary education were three times less likely to be infected, and in South Africa, which has one of the highest HIV prevalence rates in Africa, tertiary education reduced the risk of infection sevenfold.

However, Abani said the connection between HIV and education was not always made, and there were serious challenges still confronting access to schooling for girls.

Child labour was one hindrance, South African teacher Grace Maputu told delegates. "Sometimes the girls come to school very tired ... they can barely concentrate in the class after performing numerous chores," she said.

Early marriage - common in many African cultures - also halts girls' education, forcing them into often-polygamous unions with much older men.

The impact of AIDS is a double blow. In affected households, girls often drop out of school to care for sick family members; others are compelled to engage in risky transactional sex to survive, perpetuating the cycle of ignorance and HIV.

Unsurprisingly, access to education is much more difficult in remote, pastoralist areas such as northern Kenya, where girls travel long distances with their families in search of pasture for their animals.

"There is a need to have more boarding institutions for girls [in these areas], so that they can continue their education even when their families move in search of water and pasture," said Martin Simotwa, a teacher from the region.

Where girls do have access to schools, lack of teacher training in AIDS education remains an impediment. "This is due to the relationship between HIV and sexuality, and issues touching on morality ... it makes this a difficult subject," said Sabine Detzel, an education specialist with the United Nations Education, Scientific and Cultural Organisation.

"If we fail to provide education, we fail to give people the means to protect themselves," Detzel said. "We believe that the school is the best place to fight HIV."

See ActionAid report, 'Girl Power'
http://www.actionaid.org.uk/doc_lib/girl_power_2006.pdf

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

V.A News.com

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.

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.

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

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

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

Women Are More Vulnerable To HIV - Motlanthe 21/08/09

BUA News

Women's Rights a Key Factor in Fighting HIV/AIDS. 16/07/08

Business Day (South Africa) (07.16.08)::David Jackson 

Anglo Platinum, a subsidiary of the mining giant Anglo American, is sponsoring a three-year initiative that promotes women's rights in the fight against HIV/AIDS in South Africa. 

The microfinance initiative has benefited about 5,000 women in 85 villages near the company's mining operations. A report by Anglo American South Africa found that a combined microfinance and training intervention can have health and social benefits. Linking entrepreneurial training with gender and HIV/AIDS education empowers rural women financially and domestically, it said. 

According to Anglo Platinum, the initiative has contributed to a 55 percent drop in domestic rape, a significant risk for HIV transmission. Recent research has shown promising effects on HIV prevention. For example, younger participants in the program, the highest HIV risk group, became better communicators about sexuality and were more likely to have had an HIV test and used condoms. 

The HIV/AIDS infection rate for young women in developing countries is four to five times higher than for men because of women's physical vulnerability, inadequate health services and  because they typically have little control over their reproductive lives. 

Last year, the World Health Organization selected the initiative as one of its 12 global case studies that have been proven to work and can be replicated in other countries. 

Other company initiatives being considered include providing antiretroviral treatment for dependants of all South African employees who are not covered by health insurance and using public-private partnerships to overcome the challenge of HIV/AIDS.

World YWCA International Women’s Summit on HIV and AIDS. 04-07/07/07

The International Women’s Summit on HIV and AIDS, organised in partnership with the International Community of Women living with HIV (ICW), was held from July 4-7. The theme for the summit was ‘Women’s leadership on HIV and AIDS’ and it is the first-ever international conference to focus on women and AIDS.

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.

IOL

 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 www.iol.co.za by the news desk at our sister publication, The Mercury.

‘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.

Health-e

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.

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

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.

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.

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."

Intimate Partner Violence and its Links to HIV/AIDS. 3/10

Women and girls are particularly vulnerable to contracting HIV infections

Afro AIDS Info

Introduction
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.

References

Reviewed by: Hendra van Zyl

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

Introduction

Methods

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.

Results

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.

Discussion

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).

Recommendations:

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.

U.N. Official Says Women Need To Be Empowered in Fight Against HIV/AIDS. 17/10/2008

Dealing with Domestic Violence in SA. 01/07/08

Are you a victim of domestic violence? Here's what you can do to protect yourself.

Domestic violence can be identified as any controlling or abusive behaviour which harms your health, safety or well-being or the health or well-being of a child, committed within the framework of a family.

A family includes anyone who is in a domestic relationship such as married persons (married according to any law or custom) who live together as husband and wife. It also includes people living together in a relationship similar to marriage as well as parties who are of the same sex and that are/were dating, engaged or in a customary relationship, and includes children in any "family" set-up.

Domestic violence includes physical abuse or threat of physical abuse; emotional, verbal and psychological abuse; economic abuse; sexual abuse; intimidation; harassment; stalking; damage to or destruction of property or entry into your residence without consent.

If you are going to take any action against physical abuse, you should remember to take photo's of your injuries and keep record of the number of times that the abuse occurred as well as when it occurred.

There are two ways in which to deal with domestic violence:

1. You can take preventative measures to stop the violence by applying for a Protection Order against the person who is abusing you; or

2. The person that abused you will be prosecuted criminally for his/her violent offences. It is a crime to assault, intimidate or abuse someone physically or sexually. In this instance the party who has been or is being abused must report this to the police. A charge will be laid against the abusing party and The State will continue to prosecute him/her in a Criminal Court. The wrongdoer may be sentenced to prison or a fine may be imposed upon him.

Which Act regulates domestic violence?
The Domestic Violence Act 116/1998 makes provision for a person who is being abused to apply to the Magistrate's Court for a Protection Order. This is done on Application and must be granted by a Magistrate, if there is evidence supporting allegations of abuse.

Who can apply for a Protection Order?
An order may be requested by anyone who is, or was, in a domestic relationship with the respondent (abusing party).

An application for a Protection Order can be brought on behalf of the applicant by any other person with the applicant's consent. A child may also apply for a Protection Order without the assistance of his/her guardian.

The Procedure:
You must approach the Clerk of the Magistrate's Court, charged with dealing with Protection Orders, closest to where you work or live and complete and sign a Form 1 which sets out the abusive actions that must be stopped. It is important to have your attorney present as there are certain allegations that you must make in your application and affidavit. If you are able to obtain the services of an attorney you should engage his/her services as there are certain allegations that you must make in your application and affidavit. If not then the Clerk of the court will assist you."

The Clerk of the Court will submit the application and affidavits to the Court. The Court hears the Application.

If the Court is satisfied, it will grant an Interim Order with a return date on which the respondent (the abusing party) must show cause why the Interim Order should not be confirmed.

The Interim Order must be served on the respondent by the Sheriff or Peace Officer of the Court. If an order is not properly served, then it is invalid. An interim order must be served on the respondent personally and can only be acted upon if there is proof of service. The State will give financial assistance to parties who do not have the financial means to pay for service of the order themselves. The cost of service varies in different areas. The minimum cost will be R42.00 and will escalate according to the distance that the Sheriff must travel.

A Warrant of Arrest will also be issued by the Clerk for the Arrest of the respondent if he/she contravenes the Interim Order. The Clerk of the Court will send copies of the Protection order to the relevant parties as well as copies of the Protection Order and the Warrant of Arrest to a police station of the applicant's choice, normally closest to where the applicant lives.

The applicant will be protected throughout the procedure as he/she does not have to supply their address on the Protection order. When does the Protection Order expire?

The order will have force until the applicant freely and voluntarily applies for the amendment or setting aside thereof. It may also be set aside at the hearing on the return date if good cause is shown by the respondent why it should not be confirmed.

What other remedies do you have?
1. You can apply for a Peace order at a Magistrate's Court.

2. Divorce is also an option should the violence / abuse be continuous and you are married.

Who can you talk to about domestic violence?
NICRO is an organisation which runs a programme to rehabilitate perpetrators of domestic violence.

(021) 422 1690

SAPS Family Violence, Child Protection and Sexual Offences Unit Head Office: (021) 393 2363

Women Abuse Helpline: 0800 150 150

Childline: 0800 055 555

Please note this information is only meant to be used as a guideline. It is always better to consult with an experienced attorney and ensure that your attorney explains everything to you in detail until you understand.

To ask the Family Law Committee a specific question, click here.

Closing the Gap on Gender-Based Violence 15/01/2008

Protecting Widows From Dangerous Customs. 19/06/07

KISUMU, 19 June (PLUSNEWS) - Peres Atieno didn't know what AIDS was when her husband died 11 years ago, nor did she suspect she might be HIV-positive. What she did know was that custom required her to be inherited by her dead husband's brother, a relationship that would ensure she and her children were taken care of.

The ethnic Luo community of western Kenya has followed the practice known as wife inheritance for generations. However, as HIV has taken a grip on the community, the coercion of widows like Atieno into new relationships has unwittingly helped spread the virus.

Nyanza Province, on the shores of Lake Victoria, is estimated to have an HIV prevalence of over 15 percent, but in some parts of the province as many as one in four people are infected.

Fuelling the spread of HIV

When Atieno's husband died in the mid-1990s, AIDS was little more than a rumour, highly stigmatised and shrouded in silence. Her parents-in-law preferred to believe their son had been murdered.

Not long after she acquiesced to custom and married her brother-in-law, Atieno gave birth to a baby boy, but the infant died. She tested positive for the HI virus soon afterwards, but her new husband abandoned her before she could persuade him to be tested. "The rumour is he is infected," she said.

Around the village of Orongo, 10km from Kisumu, the main city in Nyanza Province, the effects of AIDS mark the landscape: homesteads stand derelict while herds of goats graze on the grass that covers scores of unmarked graves.

"Everybody from this family has died except one son; there are so many graves here," said Florence Gundo, 63, pointing to a plot of land. She set up a community-based organisation, the Orongo Widows and Orphans Group, and now dedicates herself to helping women widowed by HIV/AIDS.

The group runs a small volunteer-staffed nursery for 50 children orphaned by AIDS, who are a testament to the havoc the pandemic is wreaking on communities in the province.

Besides ignorance and stigma, Gundo believes the Luo tradition of forcing infected widows to remarry has hastened the spread of the virus in this region.

"If I don't know my status and I am inherited I might infect him," she said. "The man can then go to his home and he is going to infect his [first] wife too."

As in many ethnic communities in Kenya, a Luo man is free to marry as many women as he can support, but polygamy is widening the circle of people at risk of HIV infection.

Gundo has enlisted respected village elders to help break down the taboos that surround HIV/AIDS and encourage widows to go for testing.

"When a widow has been left behind, it is a must for her to go for an HIV test and even for the inheritor," said William Guti, a local village elder who works closely with Gundo. "If they are to come together, they must know their status."

The stigma attached to AIDS has led to a shift in the practice of wife inheritance that has done little to help widows. In-laws are increasingly turning their backs on women whose husbands have died as a result of AIDS because of the widespread assumption that they are destined to follow soon after.

Property disinheritance

Standing by the ruins of what had been her home, Milka Achieng remembered the reaction of her in-laws when she tested HIV-positive soon after the death of her husband.

"They behaved angrily and told me I could not stay there as I would only bring them another coffin," she recalled. "One day I went to town and when I returned they had removed the sheet-metal roofing. They beat me and chased me away."

Achieng and her three children have moved from house to house for over a year, living in squalid conditions in the slums of nearby Kisumu.

Traditionally, widows like Achieng have been denied the right to inherit ancestral land, which is passed down through the male line or can also be allocated by traditional chiefs.

Kenyan law now gives widows limited rights to their deceased husband's property, but in-laws are often determined to hold on to as much as they can, out of fear the woman will remarry outside of the family. Property disinheritance is a relatively new phenomenon, but is on the rise.

"Kenyan law gives a woman the right to inherit her husband's personal effects and to hold his real property, such as houses and land, in trust for their children. Interestingly, men are able to inherit the property outright if their spouse passes away," said Anne Amadi, head of litigation at the Federation of Women Lawyers Kenya, which provides legal assistance to disinherited widows.

"The origin of the widow-inheritance custom was to protect the dead man's family, but today the inheritors are using it as a way to gain access to the property; the culture is really being abused."

Florence Gundo is slowly but surely winning the support of village elders and local chiefs in helping widows win back their property, and Nyanza's widows are learning that modern Kenyan law gives them rights to property that tradition and tribal custom denied their mothers and grandmothers.

"Now I know that it is my right I can stand firm and say, 'I married your brother, I have his children; I have a right, I am the rightful custodian of this house'," said Betty Tom, 28, one of a growing number of widows in Orongo who have refused to be inherited, despite the threats of in-laws to strip them of their inheritance.

After long negotiations with the village elders, her dead husband's house was registered in her name. "My father-in-law has divided each and everybody's land; I have been given mine," Tom said. "He told me, 'this was for your husband, now this is your land and nobody is supposed to interfere with it'."

Cases like Tom's are still rare. Few women in rural areas know their rights, and fewer still are able to prove the legality of their marriage in a court of law, as most are common-law wives. Culture and superstition also prevent many men from writing a will, in the belief that it will hasten their death.

Wife Inheritance! No please. 18/01/07

When Mildred Akinyi, A HIV positive widow recently declined a proposal to be inherited, the entire community was stunned.

Her decision sparked a series of heated debates over this deeply rooted cultural practise highly prevalent in West Kenya region. But since then, Akinyi, who is a member of the St. Monica Widows Group which operates under the Catholic Archdiocese in Siaya has been viewed as a hero. Her decision has brought reprieve to countless widows in the region.

Defiant but astute many widows in Nyanza province are now breaking free from the fetters of this cultural practice.

Father Thaddaeus Oluoch, the chaplain of the Catholic Archdiocese of Kisumu while condemning the practice says it has subjected women into highly demeaning rituals.

“It involves forced ritual sex seen as a form of cleansing and the women are often harassed”

In some cases, some of the widows either get infected with the Aids virus or help spread it. However, inheritance is taking new dimension as some Luo elders at the village level in Siaya are allegedly encouraging some widows suspected to be HIV positive to hire commercial inheritors at an exorbitant fee.

Father Oluoch who works with the defiant widows, has expressed concern over the number of “commercial inheritors christened “joter” who are too costly to hire since they demand a balanced diet and huge “ugali” on top of the inheritance fee before engaging in ritual sex even with the corpse before burial.

“This has been a major set back to our endeavors since many widows are opting to pay for the services for the fear of being neglected by their in-laws and to avoid the “ghosts of the deceased” from invading the home,” says he.

The priests speaks for thousands of Luo widows suffering their agony in silence who must comply with the dictates of society and must be inherited.

The widows on the other hand revealed that they normally lure “border –border cyclists “ or ‘japer’ from a neighboring community who prefer cash, heads of cattle or decent diet and alcohol before they proceed with the ritual sex the entire night. They are then seen as the inheritors of the deceased‘s wealth. The practice has attracted many strangers from a neighboring community in Siaya District who are paid affront for the “historic game.”

One noted inheritor, name withheld said “when widows fall in love with me for ritual sex it means I have to admit a death sentence in form of illicit sex in exchange for wealth”

He further said the practice is very dangerous but lucrative and a way must be found to tame relatives who intimidate widows in forced sex with strangers “japer” just to inherit them

Some of the widows demanded that doctors be mandated to publicly declare the cause of their patients death inorder to alert the would be inheritors.

The would be inheritor is chosen by the deceased’s relatives during the funeral ceremony which last weeks as people feast and dance while others mourn..

Tired of the practice, the affected widows formed the Association through the church parishes, whose membership covers the entire Nana province. The group crusades against cultural practices in Luo community that spread HIV/Aids.

During their annual convention held at Yala Catholic Parish in August last year, the well over a thousand widows addressed the issue of wife inheritance and the debate went on unabated in the presence of stakeholders.

They unanimously layed forth the need for widows to be assisted financially, socially and spiritually as some of them according to Father Oluoch are left homeless by their irate relatives who even loot their husbands properties.

“Some widows are left in a dilapidated houses vandalized during the funeral ceremony and for the widows to build a new house, she must enter in with an axe and a cock plus a new “husband” normally on hire or the would be inheritor” .

The inheritor symbolically acts as a husband when during ground breaking ceremony of the new house and must have sex with her that night.

St.Monica group aims at empowering such widows and to help them start income generating activities.

The Group advocates for total abstinence by widows as experts on HIV/Aids believe it is among the last barriers to reversing the spread of Aids disease.

Nevertheless, clan elders feel the society has mistaken the Luos terming them as immoral and primitive. The reason for the practice they insist is to ensure the widow is taken care of even after the death if her spouse.

They say there is a fine distinction between desire and disorders which “Jater” and the widow must observe including rape prevention. Luo widows who are past menopause age also go for ritual sex to cleanse their family leading to sexual abuse.

But even so the widows remain defiant. They will hear none of it.

Advancing Women's Leadership and Advocacy for AIDS Action. Training Manual. 1/11

Published by Centre for Development and Population Activities January 2011

Abstract: Advancing Women’s Leadership and Advocacy for AIDS Action is a four-year, Ford Foundation-funded initiative designed to equip and empower a cadre of women from around the world with the knowledge and skills to strengthen and lead the global response to AIDS. Since its inception in 2006, the program has been implemented by a consortium led by the Centre for Development and Population Activities (CEDPA), which includes the International Community of Women Living with HIV/AIDS, International Center for Research on Women and the National Minority AIDS Council. The initiative has aimed to build the leadership, advocacy and technical expertise of women working on the frontlines in the fight against HIV and AIDS, and to strengthen the capacity of their organizations to advocate for stronger HIV and AIDS policies, programs and resources that meet the distinct needs of women. This manual presents a scaled-down adaptation of the training curriculum used in the project’s workshops. CEDPA has prepared this training manual as a resource for its alumni and other trainers to build the leadership, advocacy and management skills of grassroots women leaders and others working in HIV. The curriculum is intensive and highly participatory, reflective of CEDPA’s training philosophy of creating a supportive learning environment that promotes the exchange of expertise and experience.

Download this manual here (PDF, 5.7 MB, pg)

Key to Prevent HIV in Women: Reduce Gender-Based Violence. 3/7/10

The Lancet

Volume 376, Issue 9734, Pages 6 - 7

In The Lancet today, Rachel Jewkes and colleagues provide the first prospective demonstration of the role of violence from male partners in increasing women's risk of incident HIV infection. In women who were HIV negative at baseline, those experiencing violence from a male partner were more likely to become infected with HIV than were those not experiencing such violence.

Login required to access this article here

Framework for Women, Girls, and Gender Equality in National Strategic Plans on HIV and AIDS in Southern and Eastern Africa

What should a National Strategic Plan include if it meaningfully is to support women, girls and gender equality in the response to HIV/AIDS in the region? In a joint initiative between HEARD's Gender Equality and HIV Prevention Programme and the ATHENA Network, and in collaboration with over 15 endorsing regional and global civil society organisations, a Framework for Women, Girls, and Gender Equality in National Strategic Plans in Southern and Eastern Africa has been developed. This Framework outlines what NSPs in this region need to include if they are to meaningfully respond to the gendered inequalities underlying the HIV/AIDS epidemic.

The Framework is a tool to hold governments accountable in relation to their commitments around women, girls and gender equality in the context of HIV and AIDS.

The Framework for Women, Girls, and Gender Equality in National Strategic Plans in Southern and Eastern Africa is presented as an opportunity to realise critical commitments and advance important policy frameworks for women and girls, such as the African Women's Decade, the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa and the Millennium Development Goals.

The Framework can be used as a tool for NSP development or review by governmental entities such as National AIDS Councils and ministries of health and gender as well as by gender consultants or advisors.It can also support civil society participation in and mobilisation around NSP development and review.

The Framework is split into 10 sections covering key topics in relation to women, girls and gender equality, including: Prevention; Gender Based Violence; Sexual and Reproductive Rights; and Enabling Environment.

In early 2011, the ATHENA Network and the Gender Equality and HIV Prevention Programme will release the results of how NSPs in the region currently compare to the Framework.

Download this resource here  (PDF, 735,22KB, 5pg)

Gender HIV and the Church (2009) Tearfund.

• A case study on Gender, HIV and the Church written by Mandy Marshall, Idrissa Ouedraogo & Maggie Sandilands and Edited by Maggie Sandilands. Tearfund, March 2009. The case study outlines the programme in Burkina Faso and Zimbabwe over the last 3 years in working through the local church to challenge and change culturally and Biblically based attitudes on gender and sexual rights in the context of HIV and AIDS. The local organisations took a relationship based approach to gender in engaging the local church communities. The case study gives stories of transformation along with Bible studies to engage the church. The programme has seen some amazing success and outlines key aspects of the programme for replication, challenges faced and future issues to consider. Download PDF (12p.; 305.42KB).

Progress in Scale-up of Male Circumcision for HIV Prevention in Eastern and Southern Africa

Subtitle: Focus on service delivery

Abstract: WHO and UNAIDS are monitoring progress in scale-up and impact in these priority countries. As most countries have the key elements of programmes in place, the present report provides an overview of progress by the end of 2010 with a focus on the numbers of MCs performed for HIV prevention. In support of monitoring and evaluation (M&E), WHO and UNAIDS, in collaboration with PEPFAR, developed A guide to indicators for male circumcision programmes in the formal health care system3 in 2009, suggesting indicators that should be used by countries. Key indicators from the guide for which data were reported from at least some countries for 2010 and which are presented in this report include:

Contents:

Download this document here (PDF, 1.43 MB, 32 pg)

Redistributing Power: Stories from Women Leading the Fight Against AIDS

Seven extraordinary women . . .

Published by CEDPA 22 February 2011

Abstract: This book profiles seven extraordinary women who passed through the program. From civil war-torn northern Uganda to the edge of the Rocky Mountains in the United States, these women leaders share their struggles, their evolution and the passion they have for empowering those around them.
Contents:

Download this document here (PDF, 4.99 MB, 20pg)

The Global Coalition on Women and AIDS

The UNAIDS-led Global Coalition on Women and AIDS was established in 2004 to respond to the increasing feminization of the AIDS epidemic and a growing concern that existing AIDS strategies did not adequately address women’s needs.

Visit the website and view the resources.

How to Report Rape.

This article, downloaded from women24, was written based on the South African law at the time, where rape of men and boys where not included.  Rape is defined differently in the legal systems of different countries.  The exclusion of men and boys and other forms of sexul assault in this article in no way minimises the seriousness of these cases

What to do when raped

Rape in SA is woefully under-reported, and we have a shamefully low conviction rate. Here's what you need to know about rape to enable you to report it properly.    

The recent Zuma trial has once again highlighted how complicated rape cases are. The fact that there were 52 733 rape cases in 2004 is shocking – and these are only the cases that were actually reported.

What is the definition of rape?

According to our courts it is intentional, unlawful sexual intercourse with a woman or girl-child without her consent (at this stage intercourse still only refers to the penetration of the vagina by a penis). This includes rape within marriage (marital rape) and rape of a woman by the man she is going out with (date rape).

What should you do if you were raped?

· You will want to take a bath or shower after the incident, but whatever you do DON'T!! Crucial evidence will be lost. Doctors can take skin samples from under your nails or find DNA evidence in your body.

· You must go to a police station as soon as possible. You have the right to request to speak to a woman police officer in a private place.

· You may also go directly to a hospital or a district surgeon. Be careful to go to your GP, many of them are not trained to examine rape survivors and this may cause unnecessary run-around.

· Make sure the doctor tests for HIV and other sexually transmitted diseases.

· The doctor should also provide emergency contraception, antibiotics and antiretroviral medication to prevent HIV infection.

· You have a choice to either just report the incident or to lay a formal charge. Be sure to ask for a reference number and a case number.

What if you do not want to lay a charge?

If you decide not to lay a charge, you can simply report the rape to the police and request no further investigation. They must record it in their occurrence book (OB) and give you the OB number.

What happens if I decide to lay a charge?

You do not have to lay a charge immediately, but it is highly recommended that you do it as soon as possible. The quicker you do it, the easier it is to get evidence that could be crucial in making an arrest.

You can also ask the police to come to your home, if you do not want to go to the station.

You must inform the police officer if you have been drinking or have taken any drugs.

Take someone you trust with you to the police station. You have every right to ask to speak to a female police officer.

When you report the incident, you must tell the police exactly what happened to you. Every small detail can help them. If you are very upset, the police will take a short statement from you and take a longer statement later on.

You are allowed to make the statement in your home language. Be sure that you are happy with the statement, before you sign it. Remember that the court will question any changes that you make to the statement after you signed it. You may ask for a copy of your statement.

Ask for your case number – you will have to use this number if you have any questions about your case later on.

After you made your statement, the district surgeon will examine you.

What happens if they catch your attacker?

If the alleged rapist is arrested, there will be an identity parade. You will have to point him out, but you do not have to touch him. Most police stations have one-way glass, so he will not be able to see you.

There is a good chance that he will be released on bail. You have the right to attend the bail hearing and give evidence about why you think he should not be released.

Bail should not be granted if:

· He raped you more than once

· You were raped by more than one person and they were in it together

· He already has more than 2 rape charges against him

· He knew he had HIV/AIDS

· You are under 16

· You are made vulnerable by a physical disability

· You are mentally ill

· He inflicted grievous bodily harm during the rape

Who can I call?
There are various organizations that help with counseling.

Stop Women Abuse: 0800 150 150
Rape Crisis Cape Town: +27 (0)21 447 1467

Content with thanks to Rape Crisis Cape Town

Want to know more about your rights on this and other topics? Go to http://www.herlaw.co.za/.

Women's Day Resource List - AED-SATELLIFE

1. A Health Handbook for Women with Disabilities

Women with disabilities often discover that the social stigma of disability and inadequate care are greater barriers to health than the disabilities themselves. A Health Handbook for Women with Disabilities will help women with disabilities overcome these barriers and improve their general health, self-esteem, and abilities to care for themselves and participate in their communities.

Available for free downloading .

2. Facts For Feeding

Institute: LINKAGES/Academy for Educational Development

The following breastfeeding pamphlets are available:

1. Birth, Initiation of Breastfeeding, and the First Seven Days after Birth- Facts for Feeding

2. Breastmilk: A Critical Source of Vitamin A for Infants and Young Children- Facts for Feeding

3. Feeding Infants and Young Children During and After Illness

4. Feeding Low Birthweight Babies - Facts for Feeding

5. Guidelines for Appropriate Complementary Feeding of Breastfed Children 6-24 months of Age

6. Meeting the Iron Requirements of Infants and Young Children

7. Recommended Practices to Improve Infant Nutrition during the First Six Months- Facts for Feeding

Available for free download

3. Women's Studies Project Case Studies

Institute: Family Health International

Case studies profile women-centered health programs. Case studies offer lessons learned on how community members identified a reproductive health need, then created a program to meet that need. (in English and Spanish)

Available here

4. Moving Family Planning Programs Forward: Learning from Success in Zambia, Malawi, and Ghana

The Repositioning Family Planning Case Study Synthesis Report, September 2005

Institute: The ACQUIRE Project/EngenderHealth

Available for free downloading

5. Overview TRACHOMA: A Women's Health Issue

Institute: Global Alliance for Women's Health

Although few women's health advocates are familiar with this painful, disfiguring and ultimately blinding disease, and most women's health advocates do not think of trachoma as a women's health issue, the epidemiological data are compelling. Available in English and French.

Available for free downloading

6. IBP Initiative: Implementing Best Practices in Reproductive Health

The goal of the IBP Initiative is to improve access and quality of reproductive healthcare through a systematic approach focused on developing and supporting strategies that introduce, adapt and apply evidence based practices in reproductive health.

The Implementing Best Practices (IBP) Initiative is a uniquely interactive forum through which policy makers, programme managers, implementing organizations and providers convene to identify and apply evidence-based practices that can improve reproductive health outcomes in their countries.

Available here

7. Guidelines for Vaccinating Pregnant Women, October 1998 (updated September 2006)

Institute: Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (DHHS)

Available on the web and for download

8. Emergency Obstetric Care -- Checklist for Planners

Institute: UNFPA

Emergency obstetric care is the cornerstone of UNFPA's efforts to improve pregnancy outcomes. This six-panel checklist is designed to help programme planners and managers monitor elements that are critical to providing a high quality of emergency obstetric care. Available in English, Spanish, and French.

Available online

9. Sexual and Reproductive Health Needs of Women and Adolescent Girls Living with HIV. Research Report on Qualitative Findings from Brazil, Ethiopia and the Ukraine

Institutes: EngenderHealth, UNFPA

This research report explores the sexual and reproductive health intentions and needs of HIV positive women and adolescent girls in Brazil, Ethiopia and the Ukraine and probes issues relating to family planning, sexually transmitted infections, breast and cervical cancer, maternity care services and the prevention of mother-to-child transmission as well as issues of access and quality of care.

Available here

10. African Girls Scholarship Program

Institute: Academy for Educational Development Center for Gender Equity

AED program focusing on girls' education and peer leadership roles. The program helps girls complete their education, become mentors and role models, and promote HIV/AIDS education in their communities. All told, the project will provide more than 80,000 one year scholarships. Ideally, most of the girls who enter the program will remain part of it for five years, and receive five scholarships.

Learn more about the program

AED-SATELLIFE is a non-profit organization seeking to improve the health communications abilities of those in less-developed countries. They run several health related dicussion groups and publish four free electronic medical information newsletters for developing country health professionals.

For a complete list of their services please visit their website

16 Days of Activism for No Violence Against Women and Children.

Read more about the 16 Days of Activism for No Violence Against Women and Children here.

AED-SATELLIFE Resource List International Women's Day.

Women's Day Resource list compiled by Lauren Pincus, Information Officer, AED-SATELLIFE, to celebrate International Women's Day.

1. A Health Handbook for Women with Disabilities

2. Facts For Feeding

3. Women's Studies Project Case Studies

Available here

4. Moving Family Planning Programs Forward: Learning from Success in Zambia, Malawi, and Ghana

5. Overview TRACHOMA: A Women's Health Issue

6. IBP Initiative: Implementing Best Practices in Reproductive Health

7. Guidelines for Vaccinating Pregnant Women, October 1998 (updated September 2006)

8. Emergency Obstetric Care -- Checklist for Planners

9. Sexual and Reproductive Health Needs of Women and Adolescent Girls Living with HIV. Research Report on Qualitative Findings from Brazil, Ethiopia and the Ukraine

10. African Girls Scholarship Program

AED-SATELLIFE is a non-profit organization seeking to improve the health communications abilities of those in less-developed countries. They run several health related dicussion groups and publish four free electronic medical information newsletters for developing country health professionals.

For a complete list of their services please visit their website

Act Now! To End HIV and Violence Against Women

Act Now! To End HIV and Violence Against Women (Women Won’t Wait Campaign.) Key information and tools for advocacy to end HIV and violence against women.  Download PDF (11p., 283.23 KB) In this toolkit:

• Why AIDS policies have to consider violence against women
• Background on UNGASS review 2008
• The XVII International AIDS Conference, Mexico 2008
• Key Actions women’s and health rights groups can take
• Women won’t wait campaign’s proposed core and recommended targets and indicators.
• List of Resources

Decrease Violence To Decrease Risk of HIV Among Woman and Girls.

Decrease Violence To Decrease Risk of HIV Among Woman and Girls. (Global Health Council) Addressing violence against woman and HIV/AIDS simultaneously can reduce the incident of both and have a positive impact on the lives of woman and their families. This policy brief examines the way in which violence fuels increased HIV vulnerability for woman and girls. It highlights successfully and innovative efforts needed to prevent it and recommends policy action. Download PDF (257.91KB 4p).

HIV/AIDS Resource Centre for Women.

• While the number of women with HIV around the world increases, there are few places on the Web where HIV-positive women can turn for critically important information and support. That's why The Body has launched its new and improved HIV/AIDS Resource Center for Women Overflowing with practical information about living with HIV, having a baby and dealing with HIV medications, the resource center features: First-person stories from thriving HIV-positive women; Interviews with experts on the impact of HIV and HIV treatment on women; Resource listings for women seeking additional support and information; Overviews and the latest news on women and HIV.

HIV/AIDS: a War on Women.

HIV/Aids: a War on Women. (2008) openDemocracy. The author, Alice Welbourn, asks questions about the extent to which HIV policy harms women: “Numerous countries and foundations are admirably desperate to do something to curb the spread of HIV/Aids. If a policy or a model law appears that has been produced by respected "expert" institutions, it is quite understandable that they will rush to make use of them. But what if those policies or laws, although well intentioned in principle, do not work in practice? This is exactly what is happening in the international response to HIV, where a crisis is developing which is increasingly eroding the rights of women. Public health policies and legislation are being introduced which are not actually rooted in women's experiences. As a consequence, their implementation is at huge cost to women, who in their role as primary unpaid carers of their sick relatives, have in fact formed the backbone of the Aids response in the most affected communities.” Download PDF (93KB)

Human Rights, HIV/AIDS Prevention and Gender Equality. An Impossible Cocktail for Faith Based Organisations. 2008

Position Paper. (2008) The position paper is co-signed by DanChurchAid, Christian Aid, Norwegian Church Aid, FinnChurchAid, ICCO, Brot fur die Welt, Kerk in Actie.

Faith based organisations (FBO’s) have a unique possibility and responsibility to address one of the most important drivers of the AIDS pandemic, namely gender inequality. FBO’s provide moral and social leadership, establishing norms which determine how individuals with faith, and communities of individuals with faith, respond to HIV and AIDS concerns (for example, what prevention methods are acceptable, whether people living with HIV are stigmatised and discriminated against and which kind of gender behaviour that is considered acceptable). FBO’s provide, therefore, extensive existing community-based structures for responding to HIV. At the same time dealing with human sexuality and gender equality is a real challenge to most FBO’s. 

Download PDF (343.20 KB. 4p.).

Keep the Best Change the Rest.

Participatory Tools for Working with Communities on Gender and Sexuality. (International HIV/AIDS Alliance) 2007. "Gender and sexuality are cross cutting factors in the transmission of HIV and the care and support of those infected and affected. Without addressing these issues the response to the epidemic is limited. This toolkit provides a resource aimed at enabling individuals and organisations working on HIV and AIDS issues to address gender and sexuality effectively.

The toolkit gives guidance on how to build relations and trust with key community stakeholders in order to support this work; prepare facilitation teams and train them.

The toolkit contains participatory activities which enable groups of men and women of different ages to explore how gender and sexuality affect their lives and identify changes which they wish to make to improve their relationships and sexual health. It aims to establish the ongoing involvement of key stakeholders such as chiefs, traditional advisors, teachers, health workers, civil society organisations and religious and other leaders." Download in Sections.

Programming to Address Violence Against Women

Programming to Address Violence Against Women. 10 Case Studies.(UNFPA) This review documents UNFPA’s experience in the field in supporting projects that address many forms of violence against women, with the aim of disseminating lessons that can be used to confront the problem  on a wider scale. It is intended primarily for development practitioners and others seeking to change attitudes and practices that have been passed on through generations.  Breaking the cycle of violence is a necessary—and urgent—task, if the realization of women’s human rights is to become a reality in this generation.  Download PDF ( 106p; 856.65KB)

Programming to Address Violence Against Women. 10 Case Studies.

Programming to Address Violence Against Women. 10 Case Studies.(UNFPA) This review documents UNFPA’s experience in the field in supporting projects that address many forms of violence against women, with the aim of disseminating lessons that can be used to confront the problem on a wider scale. It is intended primarily for development practitioners and others seeking to change attitudes and practices that have been passed on through generations. Breaking the cycle of violence is a necessary—and urgent—task, if the realization of women’s human rights is to become a reality in this generation. Download PDF ( 106p; 856.65KB)

Promoting Gender Equality to Prevent Violence Against Women. 6/09

Published by WHO, June 1, 2009

Summary

This briefing document focuses on violence against women by intimate partners. It examines the relationship of gender inequalities to gender-based violence and finds evidence that school, community, and media interventions can promote gender equality and prevent violence against women by challenging stereotypes that give men power over women. It then describes some of the promising methods of promoting gender equality and their effectiveness. These include:

Not discussed at length, but noted as important, are government interventions to promote gender equality, such as: laws and policies on local, national, and international levels that criminalise violence against women (e.g., intimate-partner violence, rape in marriage, and trafficking for prostitution); laws and policies that support and protect those affected (e.g., implementing protection orders, child and family protection units, specialised response teams, women’s shelters, and family courts); improving the response of police and other criminal justice officials towards cases of violence against women; and improving women’s rights in marriage, divorce, property ownership, and inheritance and child support.

Content

Download PDF (18p; 591.08 KB) 

Contact

International Women's Day

International Women's Day is celebrated internationally. A global web of rich and diverse local activity connects women from all around the world ranging from political rallies, business conferences, government activities and networking events through to local women's craft markets, theatric performances, fashion parades and more.

Organisations, governments and women's groups around the world choose different themes each year that reflect global and local gender issues.

You can get more info and resources here. Also visit the special section on this website dealing with gender and HIV

Some years have seen global IWD themes honoured around the world, while in other years groups have preferred to 'localise' their own themes to make them more specific and relevant.

THEME: So while many people may think there is one global theme each year, this is not always correct. It is completely up to each country and group as to what appropriate theme they select.

Below are some of the global United Nation themes used for International Women's Day to date:

Sexual Violence and HIV.

Sexual Violence and HIV. Fact Sheet from the Sexual Violence Research Initiative. Download PDF (434 KB).

To Have and to Hold: Women’s Property and Inheritance Rights in the Context of HIV/AIDS in Sub-Saharan Africa.

To Have and to Hold: Women’s Property and Inheritance Rights in the Context of HIV/AIDS in Sub-Saharan Africa. International Center for Research on Women (ICRW), Working Paper, June 2004. Produced in association with The Global Coalition on Women and AIDS. This paper seeks to examine the link between HIV/AIDS and women’s property rights – if women’s lack of rights increases household poverty and women’s own vulnerability to infection, and if securing these rights can mitigate the impoverishing impact of the epidemic. The first section of this report explores the relationship between HIV/AIDS and women’s property and inheritance rights, and how women may be better able to prevent infection or mitigate its consequences if these rights are protected. The second section discusses the ways that women can obtain access to and control over property and how these rights are often denied in practice, and then provides several country examples. The third section explains de jure and de facto rights to ownership and inheritance and discusses how to bridge the gap when the two differ. The fourth section highlights some “best practices” in efforts to ensure women’s property and inheritance rights. The report concludes with lessons learned and suggested next steps. Download PDF.

UNHCR Handbook for the Protection of Women and Girls.

UNHCR Handbook for the Protection of Women and Girls (2008) UNHCR Division of International Protection Services (DIPS) . This handbook describes some of the protection challenges faced by women and girls of concern to the Office of the United Nations High Commissioner for Refugees (UNHCR) and outlines various strategies to tackle these challenges. The document can be downloaded by chapter, or whole. Download PDF, (4.71 MB)

Violence Against Women and HIV/AIDS.

Violence Against Women and HIV/AIDS: Critical Intersections. Intimate Partner Violence and HIV/AIDS.  World Health Organisation Information Bulletin Series, Number 1.  Content:
- Why focus on violence against women and HIV/AIDS?
- What constitutes intimate partner violence?
- The extent of the problem: Prevalence of violence against women and girls
- Where and how do intimate partner violence and HIV/AIDS intersect?
- Marital violence, condom use, and HIV risk
- HIV disclosure and violence
- Soul City
- Stepping Stones program
- Multi-sectoral approaches to address intimate partner violence and HIV/AIDS
- Conclusions and key messages Download PDF (9p; 203.68KB)

Violence Against Women and HIV/AIDS: Critical Intersections.

Violence Against Women and HIV/AIDS: Critical Intersections. Intimate Partner Violence and HIV/AIDS.  World Health Organisation Information Bulletin Series, Number 1.  Download PDF (9p; 203.68KB) . Content:

• Why focus on violence against women and HIV/AIDS?
• What constitutes intimate partner violence?
• The extent of the problem: Prevalence of violence against women and girls
• Where and how do intimate partner violence and HIV/AIDS intersect? 
• Marital violence, condom use, and HIV risk
• HIV disclosure and violence
• Soul City
• Stepping Stones program
• Multi-sectoral approaches to address intimate partner violence and HIV/AIDS
• Conclusions and key messages

What Can Men Do to Develop Healthy Relationships With Women?

What can men do to develop healthy relationships with women? Download PDF document (1 467 KB)

Women and HIV/AIDS: Confronting the Crisis.

Working With Men.

Working with men: essential to reducing the spread and impact of gender based violence and HIV and AIDS in southern Africa. Download PDF document (1154 KB).

Young Men and HIV Prevention: A Toolkit for Action