The UN High Level Meeting on AIDS is something which has taken place twice before – in 2001 and 2006. This latest one, which took place in New York last week, is the third in the 30 years history of the pandemic. It is also likely to have been the last – presumably because politicians have moved on and other pressing issues crowd their agendas. Yet for those still living with this virus every day and trying to protect others from acquiring it, there remained – and remains – much work to be done.
True there was a huge breakthrough, in that men who have sex with men were recognized for the first time as a discrete group in the “outcome document” a hugely contested 105-paragraph-long statement. But I will leave the significance of that for others to explain. Here I focus instead on what the document means – or doesn’t mean for women, and how many of us feel about it.
Well, first of all, you could be forgiven for supposing that women aren’t allowed at these meetings. The Civil Society Hearings which preceded this meeting, in early May, included a panel on which there was not one female speaker. One would have thought that, given that nearly 52% of the 34 million people with HIV worldwide are female, at least one woman might have been allowed a space on the podium. No. A few women were invited to speak from the floor – but that hardly sounds very democratic to me. How about some of the male speakers offering up their places to these women? Chance would be a fine thing. In the High Level Meeting itself, the “Thematic Panel Discussion on Women and Girls” consisted of a row of men in suits and one lone token African woman on the end of the line. These men are all very important and some are very much in support of women’s rights – including the sexual and reproductive rights of women living with HIV. I am still trying to understand, however, why such a high level panel found it so difficult to find a few more women to grace the platform. If, for example, the focus had been on medical male circumcision or on men and boys, I find it hard to imagine that men would have found it acceptable to just be stuck in the audience. Why and how do men keep managing to seize the limelight and hold onto it? Why and how do they manage to go on being so immune to any criticism of inequitable representation? How do women manage to start to claim the space that is rightly ours in such supposedly democratic processes? When will men move beyond the “calm down dear” stance? Can someone please share the answers?
How about the final outcome document, known as the “Political Declaration”, itself? Well of those 105 paragraphs, (and remember again, half of people with HIV are women), a princely (?) sum of four paragraphs were dedicated to women. And what did they focus on? Our capacity to have babies. And what was their concern about our having babies? Whether they could “eliminate mother to child transmission” or not. Care and support for women? Hardly. Interest in women as equally intelligent sentient human beings with brains, guts, initiative, resilience? Sorry? Concern for women’s sexual and reproductive rights, safety and well-being and rights to property, inheritance and access to paid work throughout the rest of our lives, (even) when we are not pregnant? Well, OK, if you must: some of this squeezed into one paragraph (no. 30). Just to drive the point home, delegates insisted on sticking to the language of “Prevention of Mother to Child Transmission”, rather than the more medical and less loaded term, “vertical transmission”, which we – and UNAIDS – had been advocating for. Hmm, you guessed it – there were quite a few of us who feel excluded by this document. It does strike us as faintly ironic that, unless you are pregnant, as a woman, you are not likely to receive any prevention education, an HIV test, or anti-retroviral treatment in most parts of the world. So whilst governments are doing their utmost to keep babies HIV free (which of course we want too), as soon as that baby girl starts to grow, she becomes hugely vulnerable to HIV until she is pregnant – and then it’s often too late for her to avoid it. (And boys, by the way, also become vulnerable to HIV – period – but that is yet another story.) What kind of effective process is that?
What is more, during the intense negotiations in the weeks and days leading to the HLM itself, there was strong resistance from the US and EU to committing to firm targets for prevention through sex, injecting drug use, “mother to child transmission”, the huge resource gap and treatment for those of us with HIV. By not firmly committing to percentages of achievement by 2015, it is extremely hard to hold governments to account for their funding commitments. Eventually, they were persuaded to include “working towards”…. targets – but not without a lot of pressure.
And what of women ourselves? What was and is our message to these delegates?
In preparation for this High Level Meeting, a number of us decided to conduct a global virtual consultation of women around the world through a quantitative and qualitative questionnaire, using Survey monkey, email and hard copies, to reach a broad range of women and girls in all our diversities. This was the first time that such a global consultation had taken place in the 30 year history of the pandemic. We were determined to try to create a process that might vaguely begin to democratize (digital divide apart) some of these UN processes. In just two weeks, after translating the questionnaire and distributing it in 9 languages, we achieved a huge response from a rich diversity of over 800 women from 95 countries worldwide. What came out loud and clear from this questionnaire were the following firm demands from women around the world, in a document which we managed to launch in a side event in New York:
• Ensure comprehensive and inclusive HIV services that address the visions, life-long needs, and rights of women and girls in all our diversity.
• Eliminate stigma and discrimination, and ensure full protection of the human rights of all women and girls, including our sexual and reproductive rights.
• Strengthen, invest in, and champion our leadership and equality to ensure the full and meaningful participation of women and girls, in particular those of us living with and affected by HIV, in the HIV response.
• Empower us to be catalysts of social justice and positive change, and eliminate all forms of violence against us.
• Ensure full access to information and education, including comprehensive sexuality education for all women and girls.
None of this is rocket-science, you might say. What is so special about our demands? You are quite right – they are indeed fairly pedestrian. We are also wondering why we are still asking for such basic issues, thirty years on. Maybe the reason why is also the one behind the plethora of men on the platforms of New York. In the words of the African parable, when elephants fight, it’s the grass that suffers. Then what will they have to survive on?
The author- Alice Welbourn is Director of the Salamander Trust and a member of the UNESCO Global Advisory Group for sex, relationships and HIV education. She is on the steering committee of the Global Coalition on Women and AIDS (GCWA) and co-founded and chairs its UK chapter the SOPHIA Forum.