By Michael Fleshman, United Nations Africa Renewal
When UN Secretary-General Ban Ki-moon appointed Elizabeth Mataka as his new special envoy for HIV/AIDS in Africa in May, he chose a respected advocate with strong ideas about how to combat the deadly disease: “Unless we empower women we will remain with very limited success,” she told Africa Renewal from her office in Lusaka. “It’s a critical emergency. We need to build capacity and women’s leadership so that they take control of programmes that are designed for the needs of women."
She speaks from experience. A citizen of Botswana, Ms. Mataka is executive director of the Zambia National AIDS Network and also serves as vice-chairperson of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which provides billions of dollars to developing countries to combat the three maladies.
Early anti-AIDS programmes, she said, failed to focus on women’s specific needs and lacked concrete goals. Simply adding women to existing AIDS programmes did not work, absent the kinds of numerical targets and time frames that have greatly increased the number of people on anti-AIDS drugs, she declared. “We must have the same thing with women’s empowerment. We must have definite programmes so that women are supported.”
The numbers bear her out. Nearly 60 per cent of the 25 million Africans living with the disease are women. The situation is little better elsewhere, with women now accounting for almost half of all infections worldwide. Dr. Peter Piot, the head of the global UN AIDS agency, noted in July that, “this is the time to connect the dots between AIDS and gender equality.” The “feminization” of AIDS is the most significant development in the evolution of the global epidemic he stated, adding: “The first question we need to ask for every AIDS activity is…‘does it pass the test for women?'"
The reasons for women’s particular vulnerability to HIV, which is transmitted by sexual intercourse and exposure to infected blood, are complex and varied. Sexual assault and other forms of violence against women is one important contributor and biology also makes women more susceptible to infection.
But the most critical factors, says Ms. Mataka, are economic, social and political. “Look at the economic position of women,” she says. “Most women find themselves totally dependent on their male partner. That tends to limit their negotiating power in terms of safer sex.
In some of the cultures we have here," she continued, "women are taught from the cradle to be subservient and obedient.” Such an upbringing, combined with economic dependence, she says, makes it very difficult for women to protect themselves. “How many women, if they went for testing, would go home and announce their status if they are positive and hope to remain in that home? And if they are thrown out of the house, what options do they have? Where do they go?”
Even women who have decided to end a dangerous or abusive relationship can find themselves isolated and trapped. “Women are under real pressure to remain in a marriage,” Ms. Mataka explained. “Mostly, society will not support a woman in her decision to divorce if she thinks that marriage is risky. People just say: ‘That’s how it is. That’s how men are.’ They need support to get away from risky situations,” she asserted, and it was up to other women to provide it.
For both men and women, the battle against AIDS remains daunting. Despite a thirtyfold increase in funding for global anti-AIDS programmes since 1996, the number of new infections and deaths continues to rise. Spending on HIV/AIDS prevention, care and treatment is expected to reach $10 bn in 2007, but that is less than half the amount needed.
Anti-retroviral drugs that attack the virus now reach 2 million people in developing countries, including over 1 million in Africa. Yet that is less than a quarter of those who need the medicines, and new infections are increasing far faster than treatment programmes. Just 11 per cent of African women receive treatment to prevent passing the virus to their newborns. In some African countries, barely one in 10 women have access to HIV testing.
But to Ms. Mataka, there are reasons for optimism. “The fatalism that I sensed maybe five or six years ago is certainly on the decline,” she says. “People think the response is in their hands and they can do something about it.” There are other modest signs of progress as well. Infection rates have begun to slow among young people in some countries, signaling that prevention programmes are beginning to work.
“There is new hope in Africa,” Ms. Mataka concluded. "People are mounting prevention and treatment programmes in the workplace, addressing issues of stigma and defending the rights of people living with HIVAIDS.” Africa still needed international support, she said, but "there must be an African solution to this problem" and Africa itself must do more. "Africa needs to realize that without dealing with the issue of women, there will be no progress in turning HIV/AIDS around.”