|Not Separate, Still Unequal: The Beijing Agreement and the Feminization of HIV/AIDS|
Not Separate, Still Unequal:
Summary: Explains how full implementation of the Beijing agreement on women's health and rights would dramatically reduce women's and girls' disproportionate vulnerability to HIV/AIDS worldwide.
The Beijing Conference stands as a milestone for women’s human rights. In 1995 the world’s governments, with leadership from the United States, adopted the Platform for Action, an outcome document agreeing that women have the right to control matters relating to their sexuality, including their sexual and reproductive health. They also discussed ways to ensure adolescents’ right to comprehensive, accurate sexuality education and health services, including access to condoms.
Ten years later, how well has the world implemented the Beijing agreement? And what are the consequences for girls and women when we fail to move forward? While there has been progress in areas like access to contraception, education, and political participation, the most telling indicator is the feminization of HIV/AIDS.
HIV/AIDS rates in general, and for girls and young women in particular, are soaring. Nearly 50% of the 38 million people living with HIV/AIDS around the world are female, up from 41% in 1997. Females now account for 62% of the people from 15 to 24 years old, living with HIV/AIDS worldwide. In sub-Saharan Africa, 75% of those living with HIV in this age group are female.
Even in Brazil, where the epidemic has stabilized in the past six years, in 2001 and 2002 the number of cases in girls under 20 was six times higher than the number of cases in boys that age. In Thailand, also considered an HIV/AIDS success story, the epidemic is advancing among women infected by husbands who visit, or have visited, sex workers, with as many as half of new infections every year occurring among cohabiting couples. Here in the United States, women accounted for 27% of new AIDS diagnoses in 2003, up from 8% in 1985. Low-income women and women of color are disproportionately affected. African American women, for example, accounted for 67% of female AIDS cases in the United States in 2003, but only 13% of the female population.
There are no band-aids or medical solutions for girls’ and women’s vulnerability. We are at least ten years away from even one preventive vaccine, and work on microbicides (topical gels or another substance that women can apply in the vaginal area to reduce transmission of HIV and other sexually transmitted diseases) while very promising, is probably at least five years away from a marketable product. A female condom that is less expensive and easier to use than the current model is under development and will ultimately be an important option for at least some women if subsidized and widely disseminated.
But as UNAIDS Executive Director Peter Piot said on World AIDS Day last year: “We will not be able to stop this epidemic unless we put women at the heart of the response to AIDS. ... The number of women living with HIV is on the rise in every region. Prevention methods such as the ABC approach—abstinence, be faithful, and use condoms—are good, but not enough to protect women where gender inequality is pervasive. We must be able to ensure that women can choose marriage, decide when and with whom they have sex, and successfully negotiate condom use.”
Full implementation of the Beijing agreement would dramatically reduce girls’ and women’s vulnerability and offers long-term solutions. The Platform for Action outlines the interventions needed, outside the health sector, to eliminate discrimination and poverty, sexual coercion and violence, and unequal power in relationships and marriage that put women and girls at risk in the first place. We must invest in programs to ensure that all girls complete at least secondary school, and that all women live free of violence, marry by choice, preferably as adults with their full consent, and have access to productive economic opportunities, including full property and inheritance rights.
When governments came together again this March to assess progress on Beijing, more than a hundred countries unanimously reaffirmed their commitment to implementing the agreement. Going forward, national and international financing must be significantly and immediately ramped up to secure women’s rights and empowerment. As Noeleen Heyzer, head of UNIFEM, has noted, in 2004 the UNIFEM Trust Fund to Eliminate Violence Against Women received $15 million in project requests, but only has $1 million in its budget.
We must also focus on what the health sector can do better to protect women and girls from HIV/AIDS in the countries most affected and those where epidemics are at the take-off stage, such as Nigeria and India. Universal access to comprehensive reproductive health services is the logical starting point. We can best reach these girls and women by strengthening and expanding access to services they already use—namely, comprehensive reproductive health services. Unlike HIV-specific clinics and education programs, which are too often stigmatized, reproductive health services have community support and a head start of several decades.
Donors, national governments, and the United Nations must provide substantially more resources to reproductive health, both to reach more girls and women, and to add HIV/AIDS-prevention capabilities to reproductive health services. If we invest wisely, we will at the same time fundamentally strengthen weak public health systems. Reproductive health service providers need updated counseling skills and information materials so that they can talk with all patients about not only HIV/AIDS, but also other STDs, and issues such as combating sexual coercion and violence, and negotiating condom use.
Investments in health and sexuality education must go hand in hand with investments in health services. The only way we can protect today’s two billion young people—and enable them to protect themselves—is to shape and implement programs that provide factual information and social support. These programs must also train and educate youth to establish equality within relationships, to end violence and sexual coercion, and to respect the right to consent in sex and marriage.
These investments will build social and political acceptance for long-lasting change. They will also bring an end to the underlying engines of the HIV epidemic—sexual violence, child marriage, skewed power in relationships, and the exclusion of young people and the unmarried from services—which drive unwanted pregnancy, maternal mortality, and wider injustice.
Inexcusably, the United States and the donor community at large, as well as other national governments, continue to duck their Beijing commitments and hedge on key HIV/AIDS prevention strategies, including sexual and reproductive services, protection of sexual and reproductive rights, and comprehensive sexuality education.
In terms of U.S. foreign policy, President Bush’s $15 billion Emergency Plan for AIDS Relief (PEPFAR) offers a critical opportunity to reverse this trend and to gain control of the HIV/AIDS pandemic. High priority for implementation should be given to the PEPFAR provisions authored by U.S. Representative Joseph Crowley (D-NY). The Crowley amendment advances programs to encourage men to be responsible for their sexual behavior; to end sexual violence and coercion, including various practices that force girls and women into dangerous sexual relations (e.g., marrying girl children to older men who have had sex with others, or widow inheritance, in which the widow is forced to marry or have sex with her deceased husband’s brother); and to increase women’s economic opportunity. Equally critical to PEPFAR’s success will be the abandonment of the dangerous and ideology-driven requirement that one-third of its prevention funds go to abstinence-only programs.
When HIV/AIDS rates start to fall in every region of the world, we will know that the world’s governments have made good on the promises of Beijing. As it did in 1995, the United States government should lead the way.
Adrienne Germain is president of the New York-based International Women’s Health Coalition, which works to protect and promote the rights and health of girls and women worldwide. She was a member of U.S. government delegations to UN conferences in the 1990s, including the 1995 Fourth World Conference on Women in Beijing.
Jennifer Kidwell is communications associate at IWHC, and will attend Columbia Mailman School of Public Health in the fall of 2005.
Copyright © 2005 National Sexuality Resource Center/San Francisco State