World AIDS day: Time for the prevention revolutionDecember 2, 2013
SOURCE: European Voice
World AIDS day was observed yestereday, prompting the question that if we are serious about eradicating AIDS we need to focus on prevention – this requires the promotion of reproductive health and family planning.
Treating the effects rather than funding prevention
Over recent years funding to tackle the consequences of AIDS in the developing world (clinics, antiretroviral drugs, etc.) has grown exponentially – now standing at seven or eight times more than it was a decade ago. Achieving such a level of donor support for treatment of the disease constitutes an outstanding success and should be held as a model for the EU's health priority in development.
However, most of this money is strictly directed at the effects of the disease – it does not, for example, go to providing contraception – and we must acknowledge that our efforts to prevent the disease are faltering. As is detailed in the UNAIDS Global Report 2013, many countries are not on track to meet targets for reducing sexual transmission of AIDS.
It is evident that, in the same way as we have had a treatment revolution, we now need a prevention revolution. For this to happen we must target the disease in women, as the primary way AIDS now spreads in many parts of the developing world is through women.
Women and girls most at risk
One such region is sub-Saharan Africa, where 76% of HIV-positive women in the world live. The majority of these are in the 15-24 age group – making it not so much woman's disease as a girl's disease. In Swaziland, the most severely impacted country in the region, a startling 46% of all women of reproductive age are infected, and life expectancy has fallen from 60 to 40 in the past decade.
Women in these countries are vulnerable to the disease because they are often not in a position to negotiate safe sex due to lower social status, sexual violence, and gender-based violence. They are also more likely than men to be uneducated and illiterate and therefore ill-informed about sexual and reproductive matters.
For those who are aware of the risks, access to contraception is often very limited. All of this is on top of the fact that women are physiologically two to four times more likely than men to become infected.
Reproductive health and family planning is crucial
Given this basket of causes, it is clear to many that the key to tackling the epidemic is integrating the promotion of reproductive health and family planning in the fight against AIDS.
As Michel Sidibé, the executive director of UNAIDS, succinctly puts it: “For a prevention revolution we need to combat public hypocrisy on sexual matters, build AIDS competencies and systematically promote sexual and reproductive health rights.”
Spelt out, this means: promoting gender equality, availability of contraception, education, addressing stigma and discrimination, and training of healthcare workers.
These are areas vital not only in preventing the spread of AIDS, but also in addressing the challenges of population and development - unwanted pregnancy, maternal mortality, fistula, unsafe abortion, gender based violence, STIs, child marriage and female genital mutilation. Countries with high rates of AIDS in young women also tend to have high instances of teenage pregnancy and unsafe abortion. The UN Population Fund 2013 State of the World Population Report shows that the majority of the 16 million 15- to 19-year-old girls giving birth each year are from sub-Saharan Africa.
Funding gap must be addressed
Yet, in stark contrast to the steep rise in funding for AIDS treatment, the international community's funding of reproductive health and family planning has seen very little increase in recent years. Sparking a prevention revolution necessarily means upping funding to these areas.
At the international level, institutions must work together to ensure that these human rights are part of the post-2015 development targets that will replace the Millennium Development Goals. Such a focus is absolutely essential if we are serious about eradicating AIDS and improving the situation of women and girls in the developing world.
This article, by European Voice, has been reproduced by PSN. Minor changes and cuts may have been made for the purpose of brevity and relevance.