Presentation by
Bunmi Makinwa, Team Leader .
UNAIDS Intercountry Team for Eastern and Southern Africa 1
At a Public Hearing of the Joint Monitoring Committee on the Improvement of the Quality of Life and Status of Women
Wednesday, September 19, 2001, Cape Town, South Africa

Honorable members of Parliament
distinguished guests and invitees,
people living with HIV and AIDS,
ladies and gentlemen of the media,
ladies and gentlemen

HIV/AIDS: IMPACT on WOMEN, GIRLS and SOCIETY

I thank you, Honorable members, for the invitation to speak before you today on HIV/AIDS and how it affects women and girls. It has become evident that the quality of society can be vastly and greatly improved if women are recognized for the vital contribution that they make in all societies. Even as the world makes remarkable progress in overcoming the discrimination and exclusion of women that was the norm for centuries, HIV/AIDS, other diseases and poverty are beginning to take with another hand what gains are made in the one hand.

Honorable Chairperson, I have a lot of respect for the institution that you head. Democracy is the best form of government until we find a better one, and Parliament is the bastion of democracy. I know this because I had, as a cabinet member, to answer to Parliament, and we took it seriously even though it was only a student parliament at our college. That the Joint Monitoring Committee on the Improvement of the Quality of Life and Status of Women decide to have its Hearings on HIV/AIDS is a recognition of the major problem that this epidemic poses.

When leaders of communities get together and discuss their problems, it is the beginning of the solution. Leaders know their people. They know their problems and they can find the way out of the problems. It cannot be different with HIV/AIDS, a major development crisis in many parts of the developing world. It is actually the biggest obstacle to social and economic progress in many of our countries in Africa. You are all too familiar with the detailed information of the steady advancement of the AIDS epidemic in Africa.

A typology of HIV/AIDS on women and girls may be seen like this:

Burden on women and girl child - Illness HIV/infection
Biological and physical
Social/economic and tradition
Policy and legislation

Impact on women and girl child - Orphans/widows
Heightened exposure to risks
Lack of access to education; poor renumeration and salary; marginalization
Exclusion; biased laws; low social status

Impact varies depending on whether the person who falls ill is female or male. In many cultures where women are the primary source of food for the household, if they become ill there is more likely to be a problem with food security for the family and society at large.

In societies where women are not allowed to own property, the death of a spouse means that a woman will lose her home and land.

Limited access to productive resources and work opportunities may compel widows to exchange sex for money, food or shelter.

The burden of caring for the sick spouse generally falls to the wife and other female members of the household. In some cases, this results in the withdrawal of young girls from schools.

In cultures where HIV is seen as a sign of sexual promiscuity, gender norms shape the way men and women infected with HIV are perceived, in that HIV-positive women face greater stigmatization and rejection than men. Gender norms also influence the way in which family members experience and cope with HIV and with AIDS deaths. For example, the burden of care often falls on females, while orphaned girls are more likely to be withdrawn from school than their brothers.

Hence, responses to the epidemic must build on an understanding of gender-related expectations and needs, and may need to challenge adverse norms.

Honorable members, UNAIDS' message is that policies from community to national level must be reshaped if women's vulnerability to HIV is to be reduced. Among other things, this means protecting their human rights and fundamental freedoms and improving their economic independence and legal status. This cannot be achieved without a greater political voice for women. I WOULD LIKE TO NOTE THAT SOUTH AFRICA IS ONE OF THE LEADING COUNTRIES IN FURTHERING ECONOMIC INDEPENDENCE, LEGAL AND POLICY STATUS OF WOMEN. It is seen obviously in parliament.

INTERNATIONAL EXPERIENCE OF PREVENTION AND CARE HIV/AIDS

UGANDA

Uganda ranks among those countries hardest hit by HIV/AIDS. Despite this, the country is fortunate to have strong political support for the control of the epidemic and a government policy of openness on AIDS. This has prompted a number of intervention strategies such as political involvement, the establishment of the Uganda AIDS Commission and National AIDS Control Programme, encouraging community response and involvement, a multisectoral approach, and fostering research.
Various studies have shown that today in Uganda there is a high level of HIV/AIDS awareness, over 80%. There is also encouraging news from studies carried out in various districts in the country, which show a change in sexual behaviour particulary among the youth. For the past five years, HIV, sexually transmitted diseases and AIDS continue to decrease in Uganda.

Some elements of sucess
Multisectoral approach
Community involvement
Strong programmes nationwide
Involvement of PLWHAs
Openess on the epidemic

SENEGAL

Senegal's HIV prevention programme has been extensive and contains the elements of an effective programme. There is good evidence that Senegal has maintained one of the lowest rates of infection in sub-saharan Africa by changing the behaviour of many citizens.

Like Uganda, Senegal is not a rich country It has 9 million people, with 44% living in towns. The total prevalence among adults is estimated at about 1.8%.

Senegal has long emphasized prevention and primary health care. Reproductive health and child health are well-established priorities.

Elements of success

Politicians were quick to move against the epidemic once the first cases appeared in the second half of the 1980s.
Since 93% of Senegalese are Muslims, the government made efforts to involve religious leaders.
By 1995, 200 NGOs were active in the response, including women's groups with about half a million members.
HIV prevention was included when sex education was introduced in schools.
Parallel efforts reached out to young people who are not in school.
HIV voluntary and confidential counselling and testing were made available.

THAILAND
Over the last two decades, Thailand has been transformed from a subsistence agrarian society into a rapidly industralizing, free-market country. This change has affected not only the labour structure, income distribution and migration patterns, but also disease patterns.

Few countries show the link between behaviour and HIV infection as clearly as Thailand. It is just more than a decade since HIV/AIDS emerged and spread in Thailand. With effective HIV surveillance system in Thailand, data are available to track prevalance, temporal trends and incidence.

Communities have played a crucial role in combating the epidemic.

Elements of success
Information
Media
Condom campaign
Multisectoral approach
Workshops and group interaction
Community involvement
Involvement of PLWHAs
Research institutions

Leaders are at a vantagepoint in relation to their people and can see directly what effects HIV/AIDS has on their communties and, can mobilize them for positive action.

Honorable members, these are extraordinary times, and extraordinary leadership is required. Women and leaders must lead us through prevention, through care and through support programmes that are vigorous and evident in having impact on the epidemic.

On the part of the United Nations family that constitutes UNAIDS, working with national and international partners, we are prepared to work with you to develop appropriate strategies. South Africa has many good examples of good and better practices that can be replicated or adapted. The United Nations is a partner with government and UNAIDS has the mandate for advocacy, coordination and dissemination of useful information and knowledge on the epidemic.

National and International partners of South Africa should recognise the efforts that are being made in this country against HIV/AIDS, and make available much more resources to assist the efforts at all levels. If the energy that is unleashed by local leaders are to bear fruits, the resources that are available to them form all sources must increase in order of magnitude far beyond what is currently available. The government of South Africa, including Parliament, should continue to strengthen its partnership with the UN Theme Group on HIV/AIDS in South Africa, the International Partnership against AIDS in Africa and other mechanisms that share its objectives to work harmoniously in the same direction.

I am glad to note that the international precedents are now firmly established. The World Conference on AIDS that was hosted in Durban last year was followed by the Africa Development Forum of Addis Ababa which focused on leadership. African Leaders met under the OAU in Abuja to reaffirm their commitment to work seriously to combat HIV/AIDS and infectious diseases, and this was followed by the unprecedented UN General Assembly on HIV/AIDS that was held in New York. All these amount to a political articulation of the problem and reaffirmed the readiness of governments and its institutions to fight AIDS.

We need a broad approach to care, not one which looks ONLY at antiretroviral (ARVs) access. Yes, antiretroviral drugs is, of course, is a vital part of the solution but we must not focus on just this issue.

Drug affordability – for all drugs not just ARVs - is a part of a matrix that also needs to include:
sustainable national financing for drug procurement and
the national and local health infrastructure required for providing care (not necessarily a perfect one though)
ensuring good nutrition.

Comprehensive and sustainable health infrastructure is must not be ignored. Planning instruments, at global and at national level, must ensure they include all three elements – affordability, sustainable procurement financing, and health infrastructure.

This is the context in which we must place the TRIPS debates. What is emerging in this debate is a new global deal between industry and society.

I would like to quote the Executive Director of UNAIDS, Dr. Peter Piot: The fastest progress to effective, sustainable and affordable care will be made by advancing on all three fronts at once. I welcome the massive attention currently on the question of drug affordability, particularly the affordability of antiretrovirals, because it necessarily also increases attention to the other elements of the care agenda. Obviously antiretroviral use is only sensible if its long-term sustainability is guaranteed, if there is sufficient health infrastructure to deliver the drugs safely and effectively, and if basic opportunistic infections are also being treated. Progress on one of these elements requires the others.

Similarly, the debate between generic and proprietary drugs is in large part a false dichotomy. The most interesting issue is the relationship between these approaches. How much does the possibility of generic production create the possibility of preferentially priced access to proprietary drugs? What are the real start-up costs of production facilities? Does South-South cooperation succeed better than North-South?

We believe in multiplying the options we have before us: with research based industry, with a global expression of interest, and in the context of TRIPS.

I would like to urge you, honorable members, to provide the right leadership that is needed to secure a reversal of the AIDS epidemic. Lead your community in a frontal attack on stigma. How can we fight a war if we pretend that we do not see it? How can we fight a killer when we pretend that it is not even killing us? In all parts of the world, the fight against stigma is a key part of the fight against HIV and AIDS. No longer can we close our eyes to the fact that people do not own up to AIDS because many people say that it is shameful to have HIV. As if sex is not part of our lives. Let us save our children from illness and death, let us tell them about AIDS and how they can avoid it. Abstain from sex, and delay start of sexual intercourse. Boys and girls can and do this now. It is cool. If you cannot, you must not dies for it. Use condoms.

In South Africa, according to Honorable Minister of Health, Dr Tshabalala Manto-Msimang, based on data from women attending ante-natal clinics, an approximate estimate can now be made of the number of people infected with HIV in South Africa.

It is known that more or less 25% of women attending ante-natal clinics are infected with HIV in South Africa. It is also Known that the rates in adult men are about 75% of those of women, and about half the South African population is over the age of 15 years.

Therefore, approximately 10% of the whole population, or about four million people, are HIV positive. The Minister also stated that approximately 4-5 million people in South Africa are infected with HIV.

UNAIDS supports the HIV/AIDS and STD Strategic Plan for South Africa 200-2005. The response to AIDS in the country is based on 5 important pillars.
They are:
Prevention and control
Treatment care and support
Social mobilization
Human and legal rights
Monitoring and research.

This response provides a viable approach to reducing the burden on HIV/AIDS on our society in South Africa. We support its implementation, vigorously and with all sectors of society. This is our hope.

Honorable members, I thank you for the honor of speaking before you.

END