HIV/AIDS Control in resource-HIV/AIDS Control in resource-poor settings, or why the ABCs poor settings, or why the ABCs are failing the African Woman: are failing the African Woman:

Francoise WelterFrancoise Welter

Policy Coordinator, GNP+Policy Coordinator, GNP+

In grateful acknowledgement to In grateful acknowledgement to

Dr. Paul Pronyk of the Department of Infectious Dr. Paul Pronyk of the Department of Infectious and Tropical Diseasesand Tropical Diseases

London School of Hygiene & Tropical MedicineLondon School of Hygiene & Tropical Medicine

HIV and developmentHIV and development

Western Europe

680 000680 000North Africa & Middle East

730 000730 000Sub-Saharan

Africa

28.2 28.2 millionmillion

Eastern Europe & Central Asia

1.8 million1.8 million

South & South-East Asia

8.2 million8.2 million

Australia & New Zealand

18 00018 000

North America

1.2 million1.2 millionCaribbean

590 000590 000

Latin America

1.9 1.9 millionmillion

2003 Total : 35-45 million2003 Total : 35-45 million 99000-E-1 – 1 December 1999

East Asia & Pacific

1.3 million1.3 million

Structural factors driving theStructural factors driving the HIV epidemic: HIV epidemic: (Parker, 2000)(Parker, 2000)

Sexual Behaviour

HIV infection

Poverty and underdevelopme

nt

Mobility and migration

Gender Inequalities

In sub-Saharan Africa, there are In sub-Saharan Africa, there are 13 women13 women infected for infected for every every 10 men10 men. Among . Among teensteens, rates among , rates among girls 5 times girls 5 times

higherhigher than boys than boys (UNAIDS 2000)(UNAIDS 2000)

0

5

10

15

20

25

30

35

<20 20-24 25-29 30-34 35-39 40-44 45-49

2000

HIV prevalence in women attending antenatal clinics by age, South Africa, HIV prevalence in women attending antenatal clinics by age, South Africa, 20002000

Women’s economic vulnerability and dependence on men increases their vulnerability to HIV by constraining their ability to

negotiate condom use, discuss fidelity, or leave risky relationships (Gupta, BMJ 2002)

Men

Women

Putting and Keeping YP in Putting and Keeping YP in School School

Streets are unsafe for YPStreets are unsafe for YP YP are safer in schools. That said, being in school does not YP are safer in schools. That said, being in school does not

automatically reduce risk and vulnerability because sex –automatically reduce risk and vulnerability because sex –consenting or coercive- is taking place in schools.consenting or coercive- is taking place in schools.

Therefore, urgent need for comprehensive sex ed.Therefore, urgent need for comprehensive sex ed. Higher educational levels associated with higher rates of Higher educational levels associated with higher rates of

condom usecondom use YP are not in school 24 hours a day, there is urgent need for YP are not in school 24 hours a day, there is urgent need for

measures from schools and other authorities to address the measures from schools and other authorities to address the needs of YP outside the classroomneeds of YP outside the classroom

According to UNFPA, each additional s/y results in 5-10% According to UNFPA, each additional s/y results in 5-10% drop in child deaths; & each 1% increase in female drop in child deaths; & each 1% increase in female schooling, with a 0.3% increase in national economic schooling, with a 0.3% increase in national economic growth.growth.

Finally, Finally, Until a fully woman-controlled prevention method is available, many Until a fully woman-controlled prevention method is available, many

women will be unable to take control of prevention. women will be unable to take control of prevention.

Microbicides are a heaven sent opportunity, but only if they challenge Microbicides are a heaven sent opportunity, but only if they challenge the gender inequality and are available to every woman who needs the gender inequality and are available to every woman who needs them. We, the stakeholders, must make sure that every woman living them. We, the stakeholders, must make sure that every woman living on the streets of Kampala, every commercial sex worker in Nairobi, on the streets of Kampala, every commercial sex worker in Nairobi, every female trader in Lilongwe, every illiterate woman in Kigali, every every female trader in Lilongwe, every illiterate woman in Kigali, every domestic in Johannesburg has free access to microbicides. domestic in Johannesburg has free access to microbicides.

It is also my personal plea that research into microbicides actively It is also my personal plea that research into microbicides actively

considers the HIV positive woman. We all know the importance of considers the HIV positive woman. We all know the importance of positive prevention, especially in settings with poor access to positive prevention, especially in settings with poor access to treatment. Microbicides would allow HIV positive women in developing treatment. Microbicides would allow HIV positive women in developing countries to prevent both repeated re-infections, but also transmissions countries to prevent both repeated re-infections, but also transmissions to others. to others.

My heartfelt thanks to Dr. Paul Pronyk of the My heartfelt thanks to Dr. Paul Pronyk of the London School of Hygiene London School of Hygiene & Tropical Medicine& Tropical Medicine for the slides and the inspiration for the slides and the inspiration

Thank you. Thank you.