Washington, DC — When the leaders of the world's largest industrial nations meet next month in Scotland, they will debate how to address the HIV/Aids crisis and whether to significantly increase assistance to Africa.
But for the summit to have a real impact on the Aids pandemic, the G8 will have to do more than increase funding; they will have to address the economic and social realities that make women and girls a special, high-risk group. Evidence from Africa shows the importance and cost-effectiveness of this strategy.
The need for such action is strikingly evident in sub-Saharan Africa, where 60 percent of those living with HIV/Aids are women and girls and where abuse and discrimination against women fuel the pandemic. On a recent trip to Africa, I visited the Chelstone Clinic, in Lusaka, Zambia, which provides free ARV treatment to women who test positive for HIV in the antenatal clinic. But the medical staff there told me about the serious challenges that women face in the fight against HIV/Aids. Upon disclosing their HIV status, women often face assault, economic abandonment and being chased from their homes. One dynamic and articulate counselor at the clinic explained the risks women take when they tell their husbands or partners about their HIV status, or try to encourage the men to be tested. "They were beaten, physically abused-with swollen eyes and bruises-and then they withdrew from the program."
The young women I talked with at a Girls High School in Zambia provided further insights into how young women live at heightened risk of HIV. As peer educators, they provide information on HIV/Aids, but, as one of them noted, "It's difficult to adhere to the information on an empty stomach." Her comment reveals how women's lack of economic empowerment puts them at risk of infection, compelling many young women to use their bodies in exchange for basic necessities. No wonder young women between the ages of 15 and 19 are infected at rates as much as seven times higher than boys their age.
Despite growing global recognition that women and girls face special risks in a world of Aids, there has been little explicit effort by the leading international donors -including the U.S. global HIV/Aids initiative, known as Pepfar -- to address the particular needs of women and girls in a systematic and comprehensive manner. "Under Pepfar," said one U.S. embassy official, "no programs are designed specifically for women. Women may benefit or participate, but the programs aren't designed for them." Comments such as these raise the important issue of why the fundamental vulnerabilities of women and girls to HIV in general are not being targeted. For their part, senior Pepfar officials have expressed concern that addressing the social and economic dimensions of women's risk are much broader than the HIV/Aids epidemic, and that addressing them would tax the limited HIV/Aids resources available through Pepfar.
The G8 leaders should tackle this head on, realizing that unless they work with national governments and civil society groups to make the gender dimension central to their approach to HIV/Aids, it will be difficult for them to reach their own goals. Further, promising models for addressing the nexus between HIV/Aids and women's social and economic empowerment already exist, and they are not cost-prohibitive.
One example is a program in Zambia called Umoyo, which in the Nyanja language means "life." It is a one-year school and training program for girls, usually orphans or otherwise vulnerable, who are chosen by their communities to take part in the program. Virtually all of them are affected by HIV/Aids and a few infected. After being given counseling, the girls enter an academic and vocational training program. More than 80 percent of the girls who graduate engage in further training, employment, or running small businesses. Girls who graduate often gain employment and become breadwinners, allowing them to provide food and school fees for their brothers and sisters. The Umoyo Training Centre program demonstrates that girls who are empowered and able to start work and venture into businesses, can better take care of themselves and their families and help reduce their risks of HIV.
The increasing attention to the Aids crisis by the G8 is significant, but the time has come for the leading industrial nations to recognize that imperatives beyond HIV/Aids or even the health sector are directly linked to women and girls' vulnerability to infection and to their ability to access and adhere to care and treatment. Ultimately, the effectiveness and sustainability of the global response to HIV/Aids requires them to meet this challenge.
Janet Fleischman is chair of the Gender Committee of the Center for Strategic and International Studies (CSIS) HIV/Aids Task Force. She recently returned from Kenya and Zambia, and published "Strengthening HIV/Aids Programs for Women: Lessons for U.S. Policy from Zambia and Kenya."