Global Health Gender and human rights dimensions and HIV/AIDS

1. Global Health Gender and human rights dimensions and HIV/AIDS Hedia Belhadj, MD, MPH Director for Partnerships UNAIDS

2. Outline • Right to health - gender and HIV • Vulnerability and inequity, determinants • Evidence and measurements • Lessons learned from AIDS response • What EU and partners can do?

3. Impact of HIV on maternal health • MDG 4, 5 and 6 represent one comprehensive package • HIV/AIDS globally the biggest cause of morbidity and mortality among women in reproductive age • 14 million children orphaned by AIDS in sub-Saharan Africa • Today, nearly 1 out of every 5 maternal deaths – total of 61,400 in 2008 – linked to HIV • Countries most affected by HIV have made least progress on maternal health, e.g. in South Africa, 50%+ of all maternal deaths linked to HIV • Access to antiretroviral treatment provides a major contribution to reduction of mortality among women

4. Women, HIV and vulnerability HIV epidemic exposed major inequalities worldwide: • Women may lose their homes, inheritance, possessions, livelihoods and even their children when their partners die. • Are forced to adopt risky survival strategies that increase chances of contracting and spreading HIV. • Up to 70% of women experience violence in their lifetime. This exposure increases risk of HIV infection by a factor of three. • Age and gender as risk factor: young women in the age 15-24 three times more at risk for HIV infection than young men • Conflicts, migration and displacement increase vulnerability • Masculinity and encouragement for multiple sexual partners

5. Barriers to access to services Women lack access to health, education and social services addressing their needs due to limited decision-making power, lack of control over financial resources, restricted mobility and child-care responsibilities. 1- Less education makes women more vulnerable to HIV infection 2- high levels of unmet needs for family planning in countries with high incidence mean that women living with HIV do not have access to sexual and reproductive health services 3- Stronger political attention to women and girls has not translated into programme and budget allocations. More than 80% of governments report focus on women as part of national plan but only 52% report specific budget allocation. 4- Cash transfers have a role in increasing health care access, which is particularly pertinent to women and babies at risk of HIV infection and care for infected children

6. Unmet need for family planning among married women 15–49 years old (%) in countries with generalized epidemic, 2006–2008

7. Percentage of pregnant women with HIV receiving ARVs for preventing MTCT of HIV in low- and middle-income countries by region, 2004–2008

8. Pregnant Women, ARVs Source: Clinton Health Access Initiative et CNLS, Cameroun, mai 2010

9. HIV, human rights and right to health Globally • One third of countries lack legal protection against discrimination based on HIV status • Only 26% of countries report laws that protect men who have sex with men • Only 21% of countries report laws that protect sex workers • Only 16% of countries report laws that protect people who use drugs • Key populations affected by HIV are stigmatized twice: • due to their HIV status • due to the fact that they belong to a constituency that is criminalized in many countries

10. Evidence and measurements People living with HIV Stigma Index • Aims to collect information on and broaden understanding of stigma, discrimination and rights of people living with HIV and provides evidence base for policy change and programmatic interventions • Rwanda PLHIV Stigma Index: 87 percent of the respondents reported that they had never been denied health services, but a large percentage (88 percent) reported being denied family planning services because of their HIV positive status in the last 12 months.

11. What have we learned from AIDS response AIDS response strengthens health systems, and by strengthening health system we deliver on all health outcomes • In Malawi, 10,000 health surveillance assistants trained and deployed in 2009 through Global Fund support to provide HIV, TB and malaria services, but also to support community-based maternal and child health, provide FP advice and conduct disease surveillance. • In Zimbabwe, government is presently using its GF funding to provide broad human resources support. AIDS response increases utilization of health services: • In Rwanda, incorporating basic HIV care into primary health centres accelerated the use of maternal, prenatal, paediatric and general health care services. • PMTCT service delivery in Côte d’Ivoire improved major maternal and child health services such as nutrition counselling during pregnancy, infant monitoring, prevention of STIs and family planning.

12. What have we learned from AIDS response Great individual, public health and socio-economic benefits in integrating services, linking HIV and sexual and reproductive health • Addresses an individual’s needs from a holistic perspective • Improved access to and uptake of services • Better access of people living with HIV to services for sexual and reproductive health which are tailored to their needs • Reduction in HIV-related stigma and discrimination • Improved coverage of underserved and vulnerable populations • Better understanding and protection of individuals’ rights • Mutually reinforcing complementarities in legal and policy frameworks • Enhanced programme effectiveness and efficiency, including better utilization of scarce human resources for health

13. What EU and partners can do • Support policy and programme development that are inclusive of and address the needs of women and key beneficiary populations • Strengthen data systems that document and acknowledge the role of communities in service delivery • Advocate legislative reforms that enhance enforcement of human rights and establish system to monitor their application • Support social protection and coverage of catastrophic health expenditure • Secure funding for community-based services • Support funding of rigorous research to develop new tools and technologies, reduce costs, address stigma as well as create novel approaches to integration • Act on financial commitments made for HIV and health, including funding of prevention, treatment, human rights protection and technical support

14. The AIDS movement - a driver for global health • Extraordinary rise in political commitment and financing for health • Scaling up of access to ARV for more than 4 million people in low- and middle income countries in five years - an unprecedented achievement in the history of public health • The commitment by G8 and other world leaders on scaling up towards universal access for HIV prevention, treatment, care and support by 2010 - the first international strive to make the right to health reality • We should build on and expand this achievement • Undermining the AIDS response would represent a significant set-back for global health • We must ensure that a focus on health system strengthening deliver the services and health outcomes people need • We should also address the determinants for poor health and barriers to services

15. Conclusion • Successful support for AIDS responses should strengthen country ownership and national processes, address the country specific realities of the epidemics and be grounded on evidence and human rights • Confronting HIV requires leaders to approach human sexuality, homophobia, sex work and drug use with human rights perspective • Addressing societal causes of HIV imperative to achieve universal access to HIV prevention, treatment, care and support • reduce human rights violation, gender inequality and stigma and discrimination associated with HIV • gender inequality, cultural and social norms restricting access to information, services and undermine women ability to protect themselves from HIV

16. Thank you.