EGM/HIV-AIDS /2000/WP 3
7 November 2000
Expert Group Meeting on
"The HIV/AIDS Pandemic and its Gender Implications"
13-17 November 2000
Gender and HIV/AIDS Update on the UN response
Division for the Advancement of Women
Department of Economic and Social Affairs (DESA)
United Nations, New York
By the end of 1999, the number of people living with HIV/AIDS was estimated to have grown from 10 million in 1990 to 34.3 million world wide, 95 per cent of which are living in developing countries. Men continue to represent the majority of cases, but the number of women infected by HIV/AIDS is increasing. While in 1997 women accounted for 41 per cent infected adults world wide, they now represent 47 per cent of all infected adults. HIV/AIDS is now the fourth leading cause of death in the world and the leading cause of death in sub-Saharan Africa, home of 71 per cent of all globally infected people and of 91 per cent of all AIDS orphans.
The seriousness of the HIV/AIDS pandemic has been pinpointed on several occasions at the international level and is now recognized as a phenomenon with wide development and human security implications. There is growing recognition that the HIV/AIDS is not just a serious health issue, but rather goes beyond it to cut cross all critical areas of concern such as poverty, the economy and human rights of women as outlined in the Beijing Platform for Action. It threatens the stability of social, political and economic development, especially in developing countries.
With 70 per cent of world wide infection occurring through unprotected sexual intercourse, women and girls are particularly vulnerable to HIV/AIDS infection due to their biological conditions as well as economic and social inequalities and culturally accepted gender roles which leave them in a subordinate position to men over decisions concerning sexual relations. As a result, HIV/AIDS has become a major challenge to gender equality and the advancement of women. By recognizing the interplay between gender and the HIV/AIDS pandemic and by looking at the social relationships that exist between men and women and their influence on both its spread and impact, the cultural, social, economic and human rights dimensions of the pandemic become more clear.
New responses, incorporating a gender dimension of the issue, need to be envisaged in all areas to increase the effectiveness of the global fight against HIV/AIDS. The necessity to take a gender sensitive approach to combating HIV/AIDS has been embodied in the Platform for Action (PfA) adopted at the Fourth World Conference on Women in Beijing (September 1995) which states that "the social, developmental and health consequences of HIV/AIDS and sexually transmitted diseases need to be seen from a gender perspective" (para 98) and has been reiterated in the outcome document of the twenty-third special session of the General Assembly. The need for an urgent response to this pandemic has intensified the response by the United Nations system.
B. THE ISSUE OF HIV/AIDS AT THE UNITED NATIONS
The Commission on the Status of Women (CSW)
The Commission on the Status of Women has repeatedly discussed women and HIV/AIDS in the follow-up to the Fourth World Conference on Women, including when it reviewed the critical area of concern "Women and Health" at its forty-third session held in March 1999. At its forty-fourth session (28 February-2 March 2000), the Commission adopted resolution 44/2 (2 March 2000), "Women, the girl child and human immunodeficiency virus/acquired immunodeficiency syndrome. Noting the increasing proportion of women living with HIV/AIDS in every region, especially in sub-Saharan Africa and among younger age groups, the Commission stressed that every effort should be made by governments, relevant United Nations agencies, funds and programmes, intergovernmental and non-governmental organizations, individually and collectively, to combat HIV/AIDS as a priority on the development agenda and to implement effective prevention strategies and programmes. It also called upon the international community to intensify its support of national efforts against HIV/AIDS, particularly in favour of women and young girls, in the worst hit regions of Africa where the pandemic is severely setting back national development gains. The Commission urged Governments, with the assistance of relevant United Nations agencies, funds and programmes, to adopt a long term, timely, coherent and integrated AIDS prevention policy, with public information and life-skills-based education programmes specifically tailored to the needs of women and girls within their sociocultural contexts and sensitivities and the specific needs in their life cycle.
The Commission has continued to express its concern over the growing rates of infection among women in every region of the world, especially in sub-Saharan Africa where women constitute 55 per cent of all adult infections. Of particular concern is the continuing violation of the human rights of women and girls, which is not only one of the root causes of women and girls infection but also one of the reasons why women are severely affected by the pandemic. Young women and girls are a specifically vulnerable group as recognized by the World Health Assembly. In various rural and urban areas of Africa, the infection rates among young women and girls are extremely high. In 7 of the 11 studies conducted on teenage girls and young women under the age of 25, more than one woman in five in her early 20s was infected with the virus; and the life expectancy rate for a large proportion of them is less than 30 years.
Compelled by recent alarming developments with regard to women and HIV/AIDS and its impact on the critical areas of concern as outlined in the PfA, the Commission decided to consider the topic as a priority theme in its work programme for the year 2001. In order to contribute to a further understanding of the issue, the Division for the Advancement of Women (DAW) decided to convene an Expert Group Meeting on "The HIV/AIDS Pandemic and its Gender Implications", in Windhoek (Namibia) from 13 to 17 November 2000. The objective the Expert Group Meeting is to contribute to a better understanding of the interplay between gender and the HIV/AIDS pandemic and the impact on the critical areas of concern of the PfA. It will discuss the multi-dimensional and cross-cutting nature of HIV/AIDS including its relation to human rights, economic, health, social and security issues in various regions. This will include consideration of womens subordination and vulnerability to discrimination which increase their risk of HIV/AIDS infection. The meeting will give particular attention to the situation of women both "infected" and "affected". The role of men vis à vis HIV/AIDS will also be discussed.
Convention on the Elimination of all forms of Discrimination against Women (CEDAW)
Article 12 of the Convention on the Elimination of Discrimination against Women calls on States parties to take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure gender equality. Specifically, in its General Recommendation on Article 12, the Committee asks States parties to report on what they have done to address the magnitude of womens ill-health, in particular when it arises from preventable conditions, such as tuberculosis and HIV/AIDS. With regard to the HIV/AIDS pandemic, particular attention must be given to the human rights of women and girls because of the discrimination, stigmatization and violence that they often face. With this in mind, the Committee on the Elimination of Discrimination against Women has been vigilant and cognizant of the need to address HIV/AIDS as a human rights issue and has therefore expressed its concern, where appropriate, to relevant State Parties during its sessions.
At its 14th (1996), 16th (1997), 18th (1998), 20th (1999) and 22nd and 23rd (2000) sessions, the Committee expressed its concern about the effect of the HIV/AIDS pandemic among young women in the context of prostitution, trafficking in women and girls, health education, lack of statistical data on HIV/AIDS, including sex-disaggregated data, and risks of mother-to-child transmission. The Committee therefore recommended more information on the prevention of HIV/AIDS, more studies and statistical data, access of prostitutes to appropriate health services, education in sexual and reproductive health, including HIV/AIDS, promotion of condom use and the increased education and services to all women on HIV/AIDS, including rural women. Noting the lack of special measures for women with HIV/AIDS on the part of some State Parties, the Committee requested more information in their next reports.
The Security Council met on 10 January 2000 in an open debate on "The impact of AIDS on peace and security in Africa." It was the first time that the Council had decided to discuss the issue of HIV/AIDS in the context of global security. During the debate, the Council recognized the magnitude of the AIDS pandemic in Southern and Eastern Africa and its threat to economic, social and political stability. It further recognized the economic costs and the need to mobilize more resources to combat the pandemic, and the President of the Council affirmed the need for a new agenda for global security in light of new global forces and challenges to international order.
As a follow up to the Security Council debate, the Economic and Social Council is pursuing special initiatives with regard to HIV/AIDS. The International Partnership against AIDS in Africa, a joint initiative of the United Nations system, African governments, donor countries, non-governmental organizations and the private sector is addressing HIV/AIDS in Africa in a concerted effort.
Deeply concerned by the extent of the HIV/AIDS pandemic worldwide, and by the severity of the crisis in Africa in particular, the Security Council adopted resolution 1308 (2000) at its 4172nd meeting on 17 July 2000. The Council stressed the need for coordinated efforts of all relevant United Nations organizations to address the HIV/AIDS pandemic in line with their respective mandates and to assist, wherever possible, in global efforts against the pandemic. The Security Council reiterated that HIV/AIDS is no longer just a health issue but can have a devastating impact on all sectors and levels of society, and may pose a risk to stability and security. The Council took note of the call of the Secretary-General in his report to the Millennium Assembly (A/54/2000) for coordinated and intensified international action to reduce the HIV/AIDS infection rates in persons 15 to 24 years of age by 25 per cent within the most affected countries before the year 2005 and by 25 per cent globally before 2010 (preambler paragraph 13). The Security Council expressed concern at the potential damaging impact of HIV/AIDS on the health of international peacekeeping personnel, including support personnel (Operative Paragraph 1) and requested the Secretary-General to take further steps towards the provision of training for peacekeeping personnel on issues related to preventing the spread of HIV/AIDS, and to continue the further development of pre-deployment orientation and ongoing training for all peacekeeping personnel on these issues (Operative Paragraph 3).
But while the Security Council must be commended for its bold and historic move to prioritize HIV/AIDS on its agenda, the Council failed to address the gender dimension of HIV/AIDS within the context of global security, including in its debate and in resolution 1308 (2000).
Five Year Reviews of the General Assembly
The five-year reviews of the General Assembly all addressed the problem of HIV/AIDS and set targets for reduction on new infections and access to appropriate health care services. The review of the International Conference on Population and Development (ICPD+5) in 1999 called for reductions in new infections by 25 per cent among 15 to 24 year-olds in the most affected countries by 2005, support in ensuring at least 90 per cent of young people have access to the necessary information, education and services to protect themselves against HIV/AIDS infection by 2005, and at least 95 per cent by 2010. Similarly the review of the International Conference on Social Development held in Geneva in June 2000, encouraged the twenty-five African countries most affected by HIV/AIDS to adopt time-bound targets for reducing infection levels, such as a target of reducing infection in young people by 25 per cent by 2005. But it was the review of the Fourth World Conference on Women that really addressed the gender dimensions of HIV/AIDS.
In the outcome document of the twenty-third special session, HIV/AIDS has been identified as of the major challenges affecting the full implementation of the Beijing Declaration and the Platform for Action. The burden of care for people living with HIV/AIDS and for children orphaned has been placed on women, and women living with HIV/AIDS often suffer discrimination and are the victims of violence. Responsible behaviour, strategies to empower women to control their own sexuality, and gender equality were some of the prerequisites identified to combat HIV/AIDS. A number of priority areas for further action was adopted relating to the prevention and treatment of HIV/AIDS such as the implementation of key actions coming out of the ICPD+5, accessible reproductive health care through primary health care to all individuals of appropriate ages no later than 2015, and achievement of specific benchmarks to reduce maternal mortality and inter alia reduce young peoples risk of HIV/AIDS.
Special Session of the General Assembly on the review of the problem of HIV/AIDS
The idea of a special session to address the global problem of HIV/AIDS and to propose new strategies and practical activities to strengthen international cooperation was brought to the attention of the Secretary-General. Consequently, at its fifty-fourth session, the General Assembly decided to convene a special session on HIV/AIDS. As outlined in General Assembly resolution 54/283 (5 September 2000), the special session would review and address the problem of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in all its aspects and coordinate and intensify international efforts to combat it, as soon as possible.
Recalling its previous resolution (54/283), the General Assembly adopted draft resolution A/55/L.13, "Review of the problem of human immunodeficiency virus/acquired immunodeficiency syndrome in all its aspects" and decided to convene, as a matter of urgency, a special session of the General Assembly, from 25 to 27 June 2001 to address and review the problem of HIV/AIDS. Unlike the Security Council resolution 1308 (2000), the issue of the gender specific impact of HIV/AIDS, especially in women and girls will be addressed during the special session.
C. PRIORITY FOCUS AREAS
The multi-dimensional and cross-cutting nature of HIV/AIDS has resulted in a number of new aspects that are now just being articulated because of new findings and a better understanding of the HIV/AIDS pandemic, especially as it relates to women and girls. Mother-to-child transmission, the female condom, mens involvement in the HIV/AIDS pandemic, human security, and prevention, treatment and care in the context of human rights are some of the issues.
Since the beginning of the HIV/AIDS pandemic, an estimated 5.1 million children worldwide have been infected with HIV/AIDS. Mother-to-child transmission is responsible for more than 90 per cent of these infections. Two-thirds are believed to occur during pregnancy and delivery, and about one-third through breastfeeding. The number of infected children increases as the number of women of childbearing age infected by HIV/AIDS rises. Each year, more than 600,000 infants become infected by HIV/AIDS, particularly in developing countries. This crisis had led to greater attention to womens access to mother-to-child prevention programmes and drug treatments, especially in developing countries. Recently, preventive treatments, including zidovudine alone, zidovudine and lamivudine, and nevirapin have been found safe for womens use without adverse effects to mother or child.
Development of the Female Condom
Womens vulnerability to HIV/AIDS because of physiological reasons and the rise in infections among women have increased the need to identify effective means of protection against the disease. The female condom provides women with another option to prevent HIV/AIDS infection and Sexually Transmitted Diseases (STDs). However, many women do not have knowledge of and access to female condom. Recently, to ensure the availability and affordability of the product, a significant reduction in price has been made and more than six million female condoms have been sold in sixteen developing countries in Africa and Asia.
There is the recognition that working with men to change their attitudes and behaviours has enormous potential to slow down the pandemic and to improve the lives of men themselves, their families and their partners. This approach therefore challenges traditional concepts of masculinity and contends that changing many commonly-held attitudes and behaviours, including the way adult men look at risk and sexuality and how boys are socialized to become men, must be part of the effort to curb the HIV/AIDS pandemic. The focus on men and HIV/AIDS should not imply the end to prevention programmes for women and girls, but rather aims to complement such programmes.
HIV/AIDS as a human security issue
There is increasing understanding that the linkage between human security and HIV/AIDS must include a gender dimension in order to ascertain the impact on women and men from the local and national levels to the global level. A critical element in fostering stability particularly in the countries most affected by HIV/AIDS is an enabling environment that will that will proactively address the obstacles to gender equality and the enjoyment of social and economic rights by all.
Prevention, treatment and care in the context of Human Rights
Although the human rights of women and girls have previously been looked at in a holistic manner, HIV/AIDS has not been the focus. Attention must therefore be paid to the need for gender-sensitive legislation to prevent discrimination, stigmatization and violence against women and girls living with HIV/AIDS. There should be the "added value" of human rights approach to make prevention, care and treatment more effective.
D. THE WAY FORWARD
Women and girls living with HIV/AIDS are exposed to serious violations of their human rights. Furthermore, this violation has implications for the well-being of the family, community and society at large. HIV/AIDS must be examined, in all its complexity, from a gender perspective in order to assist governments in developing national approaches and strategies to combating HIV/AIDS. These strategies should encompass not only the twelve critical areas of concern of the Beijing Platform for Action but should go beyond to the new emerging challenges. Gender-sensitive policies and programmes must be designed and implemented across sectors and at all levels to promote womens empowerment and reduce their vulnerability to infection. Women should therefore not only be seen as victims but as part of the solution. They should be allowed to play a central role in combating the pandemic and should therefore be empowered through education and decision-making. The multi-sectoral approach to HIV/AIDS will require increased partnerships and a broad range of actors including households, non-governmental organizations, the private sector and the international development community to effectively address the issue.