International Herald Tribune, July 9, 2003

By Kati Marton and Adrienne Germain

Across the African subcontinent, almost 60 percent of those living with HIV/AIDS are girls and women. In South Africa, women are dying at such a rate that the entire gender balance is being altered—from near parity to a ratio of 120 males to every 100 females. The implications of the feminization of AIDS are huge—for caregiving, the health and wholeness of families, social stability, policies and programs.

Saving Women From AIDS

Gaining control of this unprecedented situation requires understanding and changing the most essential—and, in most cases, the only—risk factor women face: the behavior of men.

President Bush is carrying a powerful symbol of American generosity to Africa—a $15 billion, five-year initiative to stem the HIV/AIDS pandemic. Whether this promise is transformed into effective action depends on congressional appropriation of funds and on the willingness of the administration to expand its HIV/AIDS strategy. The key question is whether it will go beyond its "ABC" approach to support programs attuned to African realities.

Abstinence—Bush's primary, preventive measure under the so-called "ABC" approach—is not an option for a girl married at 13 in Uganda, for the woman whose husband beats her regularly, or for the girl who is raped on her way to get water in Botswana. Men are the only ones who can abstain in these circumstances.

The B in ABC—be faithful to one partner—needs far more emphasis, especially with boys and men. In northern Nigeria, women have been sentenced to death by stoning for sex outside of marriage, whereas boys and men across Africa are encouraged by society to begin having sex early, to have many partners, and even to "cure" HIV/AIDS through sex with virgins.

As for the C in ABC—condom use—girls and women in Africa have little or no ability to negotiate the terms of sexual relations, and therefore condoms.

We know that forthright political leadership is required to control the spread of AIDS. President Bush has an unprecedented opportunity to provide such leadership by talking about men's behavior, and women's needs, to African leaders and the public.

In Nigeria, for example, he could refer to groundbreaking work in the east, where female genital mutilation and sexual violence are common. Eddie Madunagu has worked with 2,000 adolescent boys and men under 20, because they can learn to counter "the most backward social prejudices against women." His program, Conscientizing Male Adolescents, is instilling in a generation of Nigerian youth a new set of values about women, human rights, and citizenship. The program teaches respect, health and faithfulness—and in the process helps to protect new generations of girls and women from sexual violence, and the nation from HIV/AIDS.

Elsewhere in Nigeria, efforts are underway to empower young girls with skills that we take for granted, which they need in order to survive. The Girls' Power Initiative works with girls to teach them skills and strategies to resist unwanted sex and realize their full potential. The initiative serves more than 1,500 girls in 28 schools across four states and reaches thousands more through a newsletter and radio program.

Similarly, in the very conservative Muslim north of Nigeria, the Adolescent Health Information Project works with girls and young women in more than 150 schools on health and sexuality, as well as income earning skills and literacy. The adolescent project also works extensively with religious and other male leaders to help them understand the importance of this work.

In Nigeria, Mozambique, Uganda, Botswana, South Africa, and elsewhere, brave health workers and thoughtful leaders need U.S. support for programs that respond to the realities of girls' and women's lives. Such approaches sow the seeds for changes needed to eradicate HIV.

Engaging men and empowering women are essential complements to the ABC's of HIV/AIDS prevention. Let's hope that after witnessing Africa's realities, President Bush embraces these two E's— along with ABC.

Kati Marton is chair of the International Women's Health Coalition. Adrienne Germain is president of the International Women's Health Coalition.

Originally published in the International Herald Tribune.

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