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By Finola Finnan, Programme Leader, 1 August 2012
Can we eliminate HIV within a generation? After 30 years and over 30 million deaths, the goal of a world free from HIV appears to be within our grasp.
The scientific and technical advances in combating the spread of HIV have yielded extraordinary results. The infection rate has decreased by 20% since 1997, while the coverage of antiretrovial drugs in low and middle income countries has increased from just under half a million people to 6.6 million people in the last decade. With HIV prevalence declining in young people in many countries, there is much to celebrate.
Yet, 7,000 people still become infected with HIV every day, including 1,000 children. For every person starting treatment, two become newly infected. Last year, 1.7 million people died from AIDS-related causes.
How, then, do we build on recent successes and ensure an end to AIDS?
The UN vision is of a world with zero new infections and zero AIDS-related deaths. At the International AIDS Conference in Washington this week, there was a real belief that we are not far from seeing an AIDS-free generation. If we are to achieve this, however, we must tackle the reasons why women in the most affected countries remain so vulnerable to the virus.
Globally, women aged 15-24 are twice as likely to be infected as young men. In sub-Saharan Africa, young women aged 15-24 years are as much as eight times more likely than young men of the same age to be living with HIV. Almost one quarter of new HIV infections are recorded in young women and AIDS remains the leading cause of death of women of reproductive age.
A staggering 17 million women around the world are living with HIV today. Many women learn of their status for the first time when they attend ante-natal clinics. Without treatment, the infection is often passed on to their child, either during pregnancy, delivery or during breast-feeding. In 2010 alone, 390,000 children were born with HIV. Stopping the transmission of the virus from mother to child is, therefore, clearly a crucial step in combatting the spread of HIV.
With access to treatment, HIV positive pregnant women can give birth to HIV negative children. Women like Sekayi, whom I met in Zimbabwe. Sekayi was pregnant when she tested positive for HIV. Like many millions others, she presumed that her status would transfer to her child. With access to treatment, however, Sekayi gave birth to a healthy and happy baby, free from HIV. Sekayi is now an AIDS activist and encourages other mothers to test and avail of treatment.
For many women the path is murkier. Fear of rejection, isolation, and violence by partners and husbands silences many women. A study by Trócaire, in conjunction with NUI Galway, in Malawi points to some of the social issues that increase women’s vulnerability to HIV. A woman living in Malawi is likely to have limited control over family resources, have experienced sex at a young age, tolerate gender-based violence and believe that she has no control over her husband’s sexual behaviour outside the home. Over 90% of women believed that it was important for a man to show his wife who was boss and 74% believed that a real man feels proud when he has multiple partners. These attitudes are deeply ingrained and provide fertile ground for transmission of HIV from one generation to the next.
On the surface, international resolutions and national policies strike the right note, promoting women’s empowerment, knowledge, self-esteem and participation in order to reduce their vulnerability to HIV. The reality is often different, however. Policies are often poorly implemented and fail to promote long term changes to poverty and gender inequality. Quick fix solutions are often more acceptable than challenges to power structures and social norms that put women and girls at risk of HIV and poverty.
In June 2011, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the Global Plan to Eliminate New Infections in Children and Keep their Mothers Alive.The Plan is focused on 22 countries with the highest rates of mother to child transmission of HIV and sets an ambitious goal of reducing the number of infections in children by 90% by 2015.
However, less than half of all countries allocate resources for the specific needs of women and girls in their national response to HIV. Even when such resources do exist, the financial crisis is putting a strain on essential services such as nutrition, transport and social support. Those on the margins are often the first to suffer from tightening budgets. When these lifelines are withdrawn from people, they inevitably opt out of treatment programmes and may be forced back into high-risk situations and plunged deeper into poverty.
The elimination of HIV is within our grasp. The uncomfortable truth, however, is that the gap between what we want to achieve and where we currently are will remain elusive unless we put inequality and power at the heart of the debate.
Finola Finnan is Trócaire HIV and Gender Programme Leader and attended the International AIDS Conference in Washington as Chairperson of the Catholic HIV/AIDS Network (CHAN)
This article first appeared in The Sunday Times on July 29th, 2012.