When Michelle Obama, the first lady of the United States, visits Ghana with President Barack Obama in July, the powerful voice she has used to empower disadvantaged girls at home can be extended to Africa. By spotlighting the disproportionate impact of Aids on women and girls, she can help strengthen the Aids response - at home and abroad.
The facts of the Aids epidemic make a compelling case: the number of HIV infections among women and girls continues to rise in every region of the world, reaching 60 percent of those living with HIV/Aids in sub-Saharan Africa, including three-quarters of 15 to 24-year-olds in some severely affected countries. In the United States, Aids is the leading cause of death for black women aged between 25 and 34.
Despite progress in expanding access to Aids treatment, seen most dramatically in Africa in the past few years, the need persists to address the gender-based social and economic factors that lie outside of treatment and that continue to drive the epidemic.
In many developing countries, women are not only being hit by Aids in their economically most productive years, but they also shoulder the largest burdens of caring for others infected and affected in their families and communities.
Violations of women's rights, including violence and the threat of violence, increase women's and girls' risk of infection, and then limit their ability to access services and to protect themselves and their families. Women's lack of access to economic resources and skills training, and girls being denied education, magnify their vulnerability to HIV/Aids.
The links between HIV/Aids and family planning programs are also important. At home and abroad, family planning services help women to make informed decisions about the number and spacing of their children, which have a direct impact on key health outcomes, including child survival and maternal mortality.
Family planning programs are critical to the Aids response: sexual transmission is the primary route of HIV infection, and family planning services often serve as a gateway for women and girls to access HIV information and services. This includes helping HIV-positive women, whether they want to have children as safely as possible or whether they seek to prevent unintended pregnancies to avoid transmitting the virus to their babies.
Here in the United States, we have experienced a corrosive polarization in debates on international family planning, largely over passionately held views about abortion. To move beyond that, Mrs. Obama and other leaders can help build common ground and increase support for programs that increase women's access to these crucial services, which help reduce abortions.
In the U.S., Aids prevention efforts have languished, leading to a resurgent epidemic that is taking a heavy toll on low-income women of color. Like the global epidemic, problems associated with gender and poverty - such as poor access to quality health care, financial dependence on male partners and transactional sex for drugs, money or to meet other needs - are associated with an increase in HIV risk.
With the renewed focus now being devoted to the domestic epidemic, Mrs. Obama could help push the White House Office on Aids Policy for a revitalized strategy that addresses the pressing issues faced by women.
With the advent of the Obama administration, the issues faced by women and girls have gained new prominence, thanks in large part to Mrs. Obama's own commitment and the power of her example. There is much early evidence of a building momentum: the creation of the post of ambassador-at-large for global women's issues; the new White House Council on Women and Girls; and Secretary of State Hillary Clinton's strong recent statements endorsing women's rights and empowerment as key to the administration's foreign policy.
Mrs. Obama could make her mark on the response to the global Aids crisis by focusing on three essential strategies:
- Addressing the social and economic barriers that women and girls face in accessing Aids prevention and treatment services;
- Sensibly integrating HIV/Aids with family planning programs; and
- Ensuring the involvement of women and girls, including women living with HIV, in the design and implementation of Aids programs.
These measures would all prove the point: strengthening women in their communities to respond to the Aids crisis is vital to effective and sustainable outcomes.
Mrs. Obama has urged girls to believe in their dreams and to control their destinies. In taking on global Aids, she has the chance to help ensure that women and girls use those messages to save their lives. In the words of an HIV-positive mother in Kenya, "helping women is helping the whole family."
Janet Fleischman is a senior associate at the Global Health Policy Center of the Center for Strategic and International Studies in Washington, DC.