What Did the 2010 International AIDS Conference Mean for Women?
Washington, DC – On Wednesday, September 29th, Management Sciences for Health (MSH) hosted a Congressional Briefing, "What Did the 2010 International AIDS Conference (IAC) Mean for Women?" The event was sponsored by Congresswoman Barbara Lee (D - CA) with Women and Gender Working Group of the Global AIDS Roundtable members: the Global AIDS Alliance, Global Health Council, International Community of Women Living with HIV and AIDS Global, Ipas, and Population Action International.
"The 2010 IAC made powerful statements about women," opened Janet Fleischman Senior Associate, Center for Strategic and International Studies and moderator for this discussion, "but challenges still remain, such as funding and bottlenecks."
This event aimed to not only celebrate what has been achieved for women at the 2010 IAC but also discuss what remains and how the United States, non-governmental organizations, and the international community can address the work ahead.
The panel spoke about a variety of issues, including funding sources, global policy alignment, neglected populations, and accountability. The panel included Dr. Akudo Anyanwu Ikemba, Founder and CEO, Friends of the Global Fund Africa; Ebony Johnson, North American Representative, ICW Global; Rose Khasiala-Amolo, Senior Technical Advisor, CEDPA; Daniela Ligiero, Senior Advisor for Gender, Office of the U.S. Global AIDS Coordinator; and Catherine Severo, Project Director, Grant Management Solutions, MSH.
"This is a special moment in time where civil society and government have really organized to make sure women and girls are put on the agenda to make an impact on HIV needs," said Daniel Ligiero. "So what is PEPFAR doing for women and girls? What will happen in fiscal year 2012?"
Ligiero identified five areas that are needed or have already been established to make women and girls safe and healthy: leadership through the Together for Girls public-private partnership that addresses sexual violence as a barrier to the Millennium Development Goals, as well as creating a new budget code for gender issues in order to track spending across PEPFAR programs; a five-year Congressional mandate, which has increased gender equality, income access, and legal rights and protection for women and decreased violence; capacity building of stakeholders where much work remains; increased funding and resources to strengthen gender strategies, specifically regarding gender-based violence; and accountability to follow through on commitments in measurable ways.
However, a large window of missed opportunity exists; health workers interact with girls when they are infants receiving vaccinations and then as pregnant women, but rarely provide services to non-pregnant adolescent girls. Closing this gap and continually addressing gender issues is needed, but "without the pressure, will, and commitment, we cannot get there."
No More Wooden Nickels
"Vienna [2010 IAC] was a very powerful moment for women living with HIV&AIDS because we shared a voice and shared momentum between HIV positive women and women's groups. Together, we were able to bring a unified platform and called for actionable timelines," said Ebony Johnson.
Johnson brought the perspective of an HIV-positive woman and highlighted the need for women like her to "have a seat at the table and actively participate" when considering planning of culturally competent, accountable programs, and capacity building through mentorships in civil society.
At the IAC, "we decided we aren't going to accept wooden nickels because wooden nickels do not buy ARVs when the stock runs out," Johnson asserted. "Governments need to say that women have the right to family planning and reproductive health. That the rights of women are human rights."
She also noted that while CAPRISA's new microbicide has been met with praise, HIV-positive women see the microbicide as only part of the journey to address and prevent HIV&AIDS, not the destination or a realistic medical tool for those already infected. In that sense, Vienna was empowering, but there is much to be done for HIV-positive women.
Communities are Key
"I was really impressed by the focus on communities [at the IAC] – every discussion and event I attended talked about mobilizing, strengthening, and involving communities in planning," said Rose Khasiala-Amolo.
Strengthening health systems at the community-level directly targets women, who carry the burden of raising the family. As the most affected populations within communities, women must be equipped with advocacy skills and demand gender-related resources from government, specifically regarding the scale up of Prevention of Mother-to-Child Transmission of HIV&AIDS. Further, Khasiala-Amolo strongly emphasized the need to be trained in monitoring and evaluation and capacity building and be remunerated.
"And [the 2010 IAC] was the first time gender inequality was really focused on," she continued, "to address the lack of access for stigmatized populations of men-having-sex-with-men, injecting drug users, and sex workers." Khasiala-Amolo recommended combination preventions that address not only biomedical prevention but also behavioral and structural (policy) preventions. "When a sex worker comes in for medication, it is an opportune time to talk about behavior change and create advocacy around policy changes for a better mandate."
Integrating Programs on the Ground
"Integration is essentially the linking of policies and strategies together with services to create synergies and make a big impact," said Akudo Ikemba, CEO of Friends of Africa. Partnering with Population Action International, Friends of Africa has revived interest in reproductive health in Nigeria through Global Fund support. Integrating reproductive health into HIV work has not only increased access and use of both services but has also reduced the stigma of HIV&AIDS and has provided a dual protection to empower women to plan for their children.
While the IAC and the 2010 United Nations Summit have set up the international fora to create policies, securing resources for health at country level can be challenging. There is a crucial need for country-level capacity building that can train effective implementers and advocates. Knowledge is key to prevention; often, the women Ikemba works with in Africa do not have enough information and cannot control their own fertility.
Global Fund: A Wide Reach
"Vienna was very good for the Global Fund," said Catherine Severo. Since 2002, the Global Fund has spent $19.3 billion on HIV, tuberculosis, and malaria – $10 billion of which has supported HIV&AIDS programs. With 338 grants operating in over 100 countries, the Global Fund has a wide reach that extends beyond bilateral agreements. This accessibility to funding led to a specific message at the IAC: more money through the Global Fund.
The Global Fund is addressing gender issues through country coordinating mechanisms. Because HIV&AIDS and gender issues vary by region, the response to the epidemic is targeted to the most vulnerable and at risk populations. In that way, its policies extend beyond addressing mainstream women populations to include men having sex with men, transgendered, commercial sex workers, injecting drug users, refugees, and indigenous women.
Together, the panelists provided a breadth of expertise and perspectives that presented the unique needs, challenges, and successes of gender-inclusive HIV&AIDS programs, as well as how the current funding and policy mechanisms are driving this focus. The message was clear: women and at risk populations deserve a seat at the table.