The Miami Herald, March 31, 2003

By Adrienne Germain

President Bush's announcement of a $15 billion effort to fight HIV/AIDS in the worst affected countries may seem like a huge windfall, but when you witness the staggering impact of the disease on these countries, $15 billion starts to look more like a drop in the bucket. Unless Bush and Congress come up with a spending plan that reflects the depth and complexity of the crisis, that's exactly what it will continue to be.

Help Women, Girls Fight Against AIDS

Women and girls have been thrust to the forefront of this pandemic. In sub-Saharan Africa, they now constitute nearly 60 percent of all those infected with HIV, and HIV prevalence among girls under 18 is often four to seven times higher than among boys. Girls and women disproportionately are at risk; they have less education and little or no independent income. They lack the social support not only to lead healthy sexual lives but also to protect themselves against the virus. Sexual coercion and violence, early marriage and polygamy all contribute to higher infection rates among girls.

AIDS Has a Woman's Face
As U.N. Secretary-General Kofi Annan has declared: ''Today, AIDS has a woman's face.'' Any serious proposal to stem the HIV/AIDS pandemic must therefore have women at the center. Yet, Bush did not even mention girls or women when he talked about AIDS in Africa. A White House fact sheet on the president's HIV/AIDS initiative has no references to women. Beyond these omissions, the administration has a record of undermining programs that would help women and girls control their health and protect themselves from HIV/AIDS.

Why should a U.S. global HIV/AIDS plan address women's needs explicitly? Because any strategy to tackle the epidemic without attacking the gender discrimination that fuels it will fail. And because women are a critical force for stability, especially in societies already dangerously weakened by the impact of HIV/AIDS. Until we reduce the gender inequalities that lie at the center of the epidemic's spread, we may be able to help individuals, but we will never defeat the disease. Billions of dollars will be wasted, and millions of people will lose their lives.

Effective programs to combat HIV/AIDS must include a range of social and economic interventions to address the roles, responsibilities and vulnerabilities of women and men, as well as strengthen weak public-health systems. These programs should:

• Promote behavioral changes in boys and men to take responsibility for their sexual behavior, reject sexual and other forms of violence, and respect the rights of girls and women – including the right to say No and to negotiate safe sex.

• Eliminate discriminatory social and legal practices that are harmful to women, such as laws that prevent widows from inheriting joint property and social norms that encourage men to prey on girls in the belief that sex with a virgin can cure a man of AIDS.

• Support comprehensive healthcare strategies that are based on sound science and field-tested methodologies; increase access to and use of prevention technologies, such as male and female condoms by those who are sexually active; and address stigma, discrimination and gender disparities in access to treatment.

• Provide access to information, education and prevention technologies and to treatment to meet the specific needs of adolescents, who are at greatest risk of contracting HIV.

• Build functioning health systems that can provide the full range of preventive and curative sexual and reproductive healthcare.

Allocating the $15 billion pledge in these ways would not only ensure an effective global response but also provide solid ground for health and development into the future. If, however, social and religious conservatives trump public-health experts, we'll have wasted the $15 billion windfall and an entire generation—or two.

Adrienne Germain is president of the International Women's Health Coalition in New York City.

This article was originally published in the Miami Herald.

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