Presentation by H.H. Mr. L.C. Lekoa, Botswana's Ambassador to the United States, for World Aids Day at "Reaching Women and Girls," a conference co-hosted by CSIS Task Force and the Washington Ambassadorial Corps on November 30, 2004.
Text of the speech follows.
Mr Chairman,
Infection with the Human Immune Deficiency Virus is devastating Sub- Saharan Africa, particularly Southern Africa which is the worst hit region. The pandemic is the greatest humanitarian crisis, which has significantly reversed the developmental gains made in the region in the past decades.
According to the 2004 United Nations Global Report on the AIDS pandemic, Sub-Saharan Africa, which has just over 10% of the world's population, is home to close to two-thirds of all people living with HIV/AIDS. In 2003 alone, an estimated 3 million people in the region became newly infected, while 2.2 million died of AIDS. The HIV/AIDS is increasingly taking on a feminine face in Sub Saharan Africa. The latest findings of the AIDS Epidemic Update 2004, the annual report by UNAIDS and WHO, are that close to 60% or 13.3 million of adults living with HIV are women. In the SADC region, Botswana, Lesotho and Swaziland continue to experience HIV/AIDS prevalence rates that exceed 30% amongst pregnant women. In Botswana specifically, over 60% of the mostly infected 15-49 years category are women.
Botswana is one of the countries most affected by the HIV/AIDS pandemic in the region. The impact of this pandemic is placing a heavy burden on the individual, especially the most vulnerable groups, women and girls. The challenge facing Botswana is to find creative ways to change the social conditions that deny young women the ability to control practices that increase their vulnerability for contracting HIV.
What makes women vulnerable to HIV/AIDS generally?
Biological: Women face gender-specific risks from HIV/AIDS in a number of ways. The growing proportion of women affected by HIV /AIDS arises from a mix of physiological, social and human rights factors. Women and girls appear to have a higher inherent risk of being infected via heterosexual activity (compared to men). Studies have shown that women are more physically susceptible to HIV infection and other sexually transmitted diseases than men. Transmission from male to female during sex is about twice as likely to occur as from female-to-male transmission. A compounding factor here is the fact that women and girls are more likely to be coerced into sex or raped, often by someone older who has had greater exposure to the virus.
Cultural: Women are often expected to proof their fertility as a pre-requisite to marriage. In most cases this happens even before both parties are aware of their HIV status.
Social: Gender inequalities make women susceptible HIV/AIDS. Women frequently do not have the power to negotiate safe sex or refuse unwanted sex. In many instances, women are still seen as sexual objects. The majority of them cannot protect themselves against HIV/AIDS because they have to rely on their male partners who may decide whether or not to use a condom. Those who have been infected with HIV/AIDS find it difficult to share this important information with their partner because of fear of aggression, violence or abandonment.
Economic: HIV infection, lack of access to education, poverty and economic inequality are deeply intertwined. The burden of caring for the sick, the dying and the orphans, pushes women deeper into poverty. They are then pressurised to resort to high-risk "transactional" sex, sex in exchange for money or goods or sex with older men who offer the illusion of material security. This lack of economic independence deprives them of the choice as to when and with whom to have sexual relationships.
Prevention Strategies
Botswana regards prevention as the major pillar in the fight against the HIV/AIDS scourge. In partnership with various development partners, Botswana has been successful in meeting some of her commitments in this regard. At this stage of the pandemic the national prevention strategy is mainly focusing on behaviour change, beyond creating awareness and understanding about the pandemic. This national prevention strategy revolves around elimination of denial, stigma and discrimination. This includes:
· Intensifying Prevention of Mother to Child Transmission of HIV/AIDS. · Strengthening the management of Sexually Transmitted Infections. · Using mass media and local drama groups and other artists to promote routine HIV Testing as an integral part of the general health care. · Tapping traditional values to encourage people to engage in risk reducing practices. · Building technical capacity by training program officers and coordinators at different levels. · Community Capacity Enhancement to facilitate community dialogue on issues related to HIV/AIDS. · Promoting sexual behaviour change.
Routine testing
In January 2004, the government of Botswana introduced routine HIV testing as a measure of enhancing the existing mechanisms and health infrastructure. The tests, which are not mandatory, are also made available at prenatal and sexually transmitted disease clinics as a way of promoting Prevention of Mother to Child Transmission. Once patients have opted to be tested, pre and post-test counselling is done.
The people of Botswana have embraced routine HIV testing. Substantial increases in HIV testing, particularly in pregnant women were observed at various government sites nationwide after the introduction of routine HIV testing. Between April and June 2004, a total of 11783 people were tested for HIV at public health facilities. 3627 were male and 8156 were female. A total of 5473 tested HIV positive, 1757 being male and 3716 female.
These findings highlight the positive impact of routine HIV testing in the fight against the scourge. This has also enhanced enrolment for access to HIV prevention and treatment services. This is an indication of positive behaviour change, which may also reduce stigmatisation of the disease. However, routine HIV testing still faces the following major challenges:
· Inadequate financial and manpower resources to cater for the increasing number of patients. · Inadequate medical facilities to accommodate more patients · Inadequate medical personnel · Currently not all those who test positive and qualify, can access ARV therapy immediately.
The Government of Botswana has thus developed an aggressive multi sectoral strategy to confront the epidemic in all fronts. Some interventions specific to women and girls in include Prevention of Mother to Child Transmission, prevention efforts through behavioural change, care and support through a combination of home based care and anti-retroviral therapy. The female condom has also been widely promoted as a potentially important female controlled form of protection that is readily available.
The Government of Botswana has also demonstrated commitment to supporting women in the fight against HIV/AIDS by putting in place programs specific for Women and Girls. Education for girls is highly promoted. Psychosocial support in the form of counselling is provided to women, especially the home based caregivers. Women are educated on HIV/AIDS gender based violence and also receiving training on HIV/AIDS and human rights. The government also gives support to orphans and vulnerable children. As part of the interventions, a food basket and additional support for schooling are provided free to all registered orphans. Botswana is also adopting a human rights-based approach to HIV/AIDS and the protection/empowerment of women and girls by providing shelter to women and children experiencing domestic violence.
Regional initiatives
In the SADC region, HIV/AIDS is no longer considered a mere health problem only, but a developmental one as well. The focus is both on the prevention of HIV and AIDS on the one hand, and the mitigation of its impact in order to ensure sustainable human development of member states. This understanding has made combating the epidemic a top priority in the agenda of SADC. Member states have shifted their response away from one that focuses primarily on health-related aspects of the epidemic, to strategic multisectoral and multidimensional interventions.
SADC aims to have consistent policies and programmes across the region by coordinating and harmonising the development of policies and strategies in major intervention areas, including prevention, care and treatment, provision of ARVs, nutrition, traditional medicines, procurement and manufacturing of essential drugs and medical supplies of HIV and AIDS. SADC also aims at integrating HIV and AIDS solutions in all regional policies and programmes.
The Maseru Declaration signed by SADC Heads of State on July 4th 2003, has declared the following as areas specific for women, and requiring the region's urgent attention; a) Creating a sustaining and enabling environment conducive to gender balance, rapid and broad based socio- economic development of the region and addressing major underlying factors that lead to the spread of the disease. b) Increasing the capacities of women and adolescent girls to protect themselves from the risk of HIV/AIDS infection. This is principally through the provision of health care and health services, including for sexual reproductive health and through prevention education that promotes gender equality within a culturally and gender sensitive framework. c) Rapildy scaling up the programmes for the prevention of Mother to Child Transmission of HIV and ensure the levels of uptake are sufficient to achieve the desired public impact. SADC has also identified the following areas as critical for the fight against HIV/AIDS:
· Human Resources: This involves training, skills development and ensuring access to educational systems for all. Member states also want to look into better ways of sustaining educational systems and ensure their funding;
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· Food Security: Addressing all aspects of agriculture that relate to the mitigation of the impact of HIV/AIDS, and issues of food entitlements and of nutrition;
· Health Systems: Sustaining health systems, including human resource needs, access to care and treatment for all;
· Mitigating Social and Economic Impact: Looking into all aspects of policy development relating to support for HIV affected persons and communities. This includes addressing issues of orphans, youth employment, and putting in place workplace programmes on HIV/AIDS, and so on.
· HIV Prevention: Addressing aspects of regional policy development, such as policies for mobile and migrant populations within the region, poverty programmes, access to health care systems by both legal and illegal migrants;
· Gender issues: Putting in place comprehensive policies and programmes as a response to the problems facing women who not only account for the largest number of those infected with HIV, but are also critical for all aspects of coping with the socio-economic impact of the epidemic.
Governments need to address the following areas in order to relieve women of the heavy burden upon them brought about by HIV/AIDS. The leadership has to address this problem not only for the nation, but also for the innocent children affected;
1. Human Rights, which are women rights 2. Property Rights 3. Education for girls 4. Economic independence for women 5. Prevention of violence against women and children 6. Do away with cultures and traditions that fan the spread the disease 7. Boys and Men need to be part of the solution
In conclusion, this what the Ambassador of Swaziland Her Excellency Mary Kanya said:
"HIV/AIDS is a Holocaust, the black plague of our century, reaching all continent, class and races. It was not anticipated financially and policy wise. It is causing untold damage. It needs international response that puts it into perspective instead of using it as a political tool. More people are dying now than the people that died in the First and Second World Wars."
If HIV/AIDS is to be defeated, the world needs to work together to make a difference in the lives of those who have been infected and affected, especially women.
Thank you for your attention.
