PHA-Exchange> In preparation of PHA2 (40) --Stephen Lewis on women and HIV/AIDS

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Can't miss this one!

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> Text of a speech by Stephen Lewis, UN Special Envoy for HIV/AIDS in
> Africa, delivered at the University of Pennsylvania's Summit on Global
> Issues in Women's Health, Philadelphia, April 26, 2005.


> I well realize that this is a conference on women's global health, and
> everything I'm about to say will apply to that generic definition. But
> the more I thought of the subject matter, the more I want to use
> HIV/AIDS in Africa as a surrogate for every international issue of
> women's health, partly because it's what I know best; partly because
> it's an accurate reflection of reality.
>
> I've been in the Envoy role for four years. Things are changing in an
> incremental, if painfully glacial way. It's now possible to feel merely
> catastrophic rather than apocalyptic. Initiatives on treatment,
> resources, training, capacity, infrastructure and prevention are
> underway. But one factor is largely impervious to change: the situation
> of women. On the ground, where it counts, where the wily words confront
> reality, the lives of women are as mercilessly desperate as they have
> always been in the last twenty plus years of the pandemic.
>
> Just a few weeks ago, I was in Zambia, visiting a district well outside
> of Lusaka. We were taken to a rural village to see an "income generating
> project" run by a group of Women Living With AIDS. They were gathered
> under a large banner proclaiming their identity, some fifteen or twenty
> women, all living with the virus, all looking after orphans. They were
> standing proudly beside the income generating project . a bountiful
> cabbage patch. After they had spoken volubly and eloquently about their
> needs and the needs of their children (as always, hunger led the
> litany), I asked about the cabbages.. I assumed it supplemented their
> diet? Yes, they chorused. And you sell the surplus at market? An
> energetic nodding of heads. And I take it you make a profit? Yes again.
> What do you do with the profit? And this time there was an almost
> quizzical response as if to say what kind of ridiculous question is that
> .. surely you knew the answer before you asked: "We buy coffins of
> course; we never have enough coffins".
>
> It's at moments like that when I feel the world has gone mad. That's no
> existential spasm on my part. I simply don't know how otherwise to
> characterize what we're doing to half of humankind.
>
> I want to remind you that it took until the Bangkok AIDS conference in
> 2004
> --- more than twenty years into the pandemic --- before the definitive
> report from UNAIDS disaggregated the statistics and commented,
> extensively, upon the devastating vulnerability of women. The phrase
> "AIDS has a woman's face" actually gained currency at the AIDS
> conference in Barcelona two years earlier, in 2002, and even then it was
> years late. Perhaps we should stop using it now as though it has a
> revelatory dimension. The women of Africa have always known whose face
> it is that's withered and aching from the virus.
>
> I want to remind you that when the Millennium Development Goals were
> launched, there was no goal on sexual and reproductive health. How was
> that possible? Everyone is now scrambling to find a way to make sexual
> and reproductive health fit comfortably into HIV/AIDS or women's
> empowerment or maternal mortality. But it surely should have had a
> category, a goal, of its own. Interestingly, the primacy of women is
> rescued (albeit there's still no
> goal) in the Millennium Project document, authored by Jeffrey Sachs.
>
> And while mentioning maternal mortality, allow me to point out that this
> issue has been haunting the lives of women for generations. I can
> remember back in the late 90s, when I was overseeing the publication of
> State of the World's Children for UNICEF, and we did a major piece on
> maternal mortality and realized that the same number of annual deaths
> --- between 500 and 600 hundred thousand --- had not changed for twenty
> years. And now it's thirty years. You can bet that if there was
> something called paternal mortality, the numbers wouldn't be frozen in
> time for three decades.
>
> I want to remind you that within the UN system, there's something called
> the Task Force on Women and AIDS in Southern Africa. Permit me to tell
> you how it came about, and where it appears to be headed . and I beg you
> to see this as descriptive rather than self-indulgent.
>
> In January of 2003, I traveled with the Executive Director of the World
> Food Programme, James Morris, to four African countries beset by a
> combination of famine and AIDS: Zimbabwe, Zambia, Malawi and Lesotho. We
> had surmised, at the outset, that we would be dealing primarily with
> drought and erratic rainfall, but in the field it became apparent that
> to a devastating extent, agricultural productivity and household food
> security were being clobbered by AIDS. We were shocked by the human
> toll, the numbers of orphans, and the pervasive death amongst the female
> population. In fact, so distressed were we about the decimation of
> women, that we appealed to the Secretary-General of the United Nations
> to personally intervene.
>
> And he did. He summoned a high level meeting on the 38th floor of the UN
> Secretariat, with TV conferencing outreach to James Morris in Rome and
> to the various UN agencies in Geneva, and after several agitated
> interventions, the Secretary-General struck a Task Force on Gender and
> AIDS in Southern Africa, to be chaired by Carol Bellamy of UNICEF.
>
> If memory serves me, Carol Bellamy determined to focus on seven of the
> highest prevalence rate countries: studies were done, recommendations
> were made, costs of implementation were estimated, monographs were
> published.. And here's what festers in the craw: the funding for
> implementation is not yet available. The needs and rights of women never
> command singular urgency..
>
> There's an odd footnote to this. Within the last two months, a number of
> senior students at the University of Toronto Law School, compiled papers
> dealing with potential legal interventions on a number of issues related
> to HIV/AIDS in Africa. One of the issues was, predictably, gender. Not a
> single student, over the course of several weeks, whether on the
> internet or wider personal reading, came across the Secretary-General's
> Task Force (although one student said that she had a vague recollection
> that such a thing existed). The Task Force findings are clearly not
> something the UN promotes with messianic fervour.
>
> I want to remind you that as recently as March, there was tabled,
> internationally, the Commission on Africa, chaired by Prime Minister
> Tony Blair . indeed established by Tony Blair. It has received nothing
> but accolades, particularly for the analysis and recommendations on
> Official Development Assistance, on trade and on debt. The tributes are
> deserved.. The document goes further down a progressive road than any
> other contemporary international compilation.
>
> With one exception. I want it to be known --- because it's not known ---
> that the one aspect of this prestigious report which fails, lamentably,
> is the way in which it deals with women. There is the occasional
> obligatory paragraph which signals that the Commission recognizes that
> there are two sexes in the world, but by and large, given that women are
> absolutely central to the very integrity and survival of the African
> continent, they are dealt with as they are always dealt with in these
> auspicious studies: at the margins, in passing, pro forma. And it's not
> just HIV/AIDS; it's everything, from trade to agriculture to conflict to
> peace-building.
>
> Maybe we should have guessed what was coming when there were only three
> women appointed out of seventeen commissioners. They had the whole world
> to choose from, and they could find only three women . it doesn't even
> begin to meet the Beijing minimum target of thirty percent. We're not
> just climbing uphill; we might as well be facing the Himalayas.
>
> I want to remind you, finally, of the arrangements we've made within the
> United Nations itself. HIV/AIDS is the worst plague this world is
> facing; it wrecks havoc on women and girls, and within the multilateral
> system, best-placed to confront the pandemic, we have absolutely no
> agency of power to promote women's development, to offer advice and
> technical assistance to governments on their behalf, and to oversee
> programmes, as well as representing the rights of women. We have no
> agency of authority to intervene on behalf of half the human race.
> Despite the mantra of 'Women's Rights are Human Rights', intoned at the
> International Conference on Human Rights in  Vienna in 1993; despite the
> pugnacious assertion of the rights of women advanced at the Cairo
> International conference in 1994; despite the Beijing Conference on
> women in 1995; despite the existence of the Convention on the
> Elimination of Discrimination against Women, now ratified by over 150
> countries; we have only UNIFEM, the UN Development Fund for Women, with
> an annual core budget in the vicinity of $20 million dollars, to
> represent the women of the world. There are several UNICEF offices in
> individual developing countries where the annual budget is greater than
> that of UNIFEM.
>
> More, UNIFEM isn't even a free-standing entity. It's a department of the
> UNDP (the United Nations Development Programme). Its Executive Director
> ranks lower in grade than over a dozen of her colleagues within UNDP,
> and lower in rank than the vast majority of the Secretary-General's
> Special Representatives.
>
> More still, because UNIFEM is so marginalized, there's nobody to
> represent women adequately on the group of co-sponsors convened by
> UNAIDS. You see, UNAIDS is a coordinating body: it coordinates the AIDS
> activities of UNICEF, UNDP, the World Bank, UNESCO, UNFPA, WHO, UNDCP
> (the Drug Agency), ILO and WFP. UNIFEM asked to be a co-sponsor, but it
> was denied that privilege.
>
> So who, I ask, speaks for women at the heart of the pandemic? Well,
> UNFPA in part. And UNICEF, in part (a smaller part). And ostensibly UNDP
> (although from my observations in the field, "ostensible" is the
> operative word).
>
> Let me be clear: what we have here is the most ferocious assault ever
> made by a communicable disease on women's health, and there is just no
> concerted coalition of forces to go to the barricades on women's behalf.
> We do have the Global Coalition on Women and AIDS, launched almost by
> way of desperation, by some international women leaders . like Mary
> Robinson, like Geeta Rao Gupta, but they're struggling for significant
> sustainable funding, and their presence on the ground is inevitably
> peripheral.
>
> I was listening to the presentations at the dinner last night, and
> thinking to myself, when in heaven's name does it end? Obstetric fistula
> causes such awful misery, and isn't it symptomatic that one of the
> largest --- perhaps the largest --- contributions to addressing this
> appalling condition has come not from a government but from Oprah
> Winfrey?
>
> I was noting, just in the last 48 hours, that Save the Children in the
> UK has released a report pointing out that fully half of the three
> hundred thousand child soldiers in the world are girls. And if that
> isn't a maiming of health --- in this case emotional and psychological
> health --- then I don't know what is. And perhaps you notice the rancid
> irony: women have achieved parity on the receiving end of conflict and
> AIDS, but nowhere else.
>
> Female genital mutilation, the contagion of violence against women,
> sexual violence in particular, rape as a weapon of war --- Rwanda,
> Darfur, Northern Uganda, Eastern Congo --- marital rape, child
> defilement, as it is called in Zambia, sexual trafficking, maternal
> mortality, early marriage . I pause to point out that studies now show
> that in parts of Africa, the prevalence rates of HIV in marriage are
> often higher than they are for sexually active single women in the
> surrounding community; who would have thought that possible? .
>
> The overall subject matters you're tackling at this conference strike to
> the heart of the human condition. All my adult life I have accepted the
> feminist analysis of male power and authority. But perhaps because of an
> acute naiveté, I never imagined that the analysis would be overwhelmed
> by the objective historical realities. Of course the women's movement
> has had great successes, but the contemporary global struggle to secure
> women's health seems to me to be a challenge of almost insuperable
> dimension.
>
> And because I believe that, and because I see the evidence month after
> month, week after week, day after day, in the unremitting carnage of
> women and AIDS --- God it tears the heart from the body . I just don't
> know how to convey it . these young young women, who crave so
> desperately to live, who suddenly face a pox, a scourge which tears
> their life from them before they have a life . who can't even get
> treatment because the men are first in line, or the treatment rolls out
> at such a paralytic snail's pace . who are part of the 90% of pregnant
> women who have no access to the prevention of Mother to Child
> Transmission and so their infants are born positive . who carry the
> entire burden of care even while they're sick, tending to the family,
> carrying the water, tilling the fields, looking after the orphans . the
> women who lose their property, and have no inheritance rights, and no
> legal or jurisprudential infrastructure which will guarantee those
> rights . no criminal code which will stop the violence . because I have
> observed all of that, and have observed it for four years, and am driven
> to distraction by the recognition that it will continue, I want a kind
> of revolution in the world's response, not another stab at institutional
> reform, but a virtual revolution.
>
> Let me, therefore, put before the conference, two quite pragmatic
> responses which will make a world of difference to women, and then a
> much more fundamental proposal.
>
> Many at the conference will not know this, but the Kingdom of Swaziland
> recently made history when it received from the Global Fund on AIDS,
> Tuberculosis and Malaria, money to pay a stipend --- modest of course,
> but of huge impact --- to ten thousand caregivers, looking after
> orphans, the vast majority being women. The Swaziland National AIDS
> Commission (that may not be the precise name), reeling from the
> exploding orphan population, made the proposal for payment to the Global
> Fund, and it swept through the review process with nary a word. The
> amount is roughly $30/month, or a dollar a day . not a lot to be sure,
> but clearly enough to make a great difference.
>
> My recommendation is that this conference orchestrate the writing of a
> letter, to be signed by people like Mary Robinson, Geeta Rao Gupta, and
> prominent women from academia, and have that letter sent to every
> African Head of State and Minister of Health, urging them to ask for
> compensation for caregivers, using the Swaziland precedent.
>
> And the second pragmatic proposal? I would recommend, with every fibre
> of persuasion at my command, that the conference collaborate directly
> with the International Partnership on Microbicides, whose remarkably
> effective Executive Director, Dr. Zeda Rosenberg, will be here on campus
> on Thursday. She will tell you what she needs and how to go about
> getting it. The prospect of a microbicide, in the form of a gel or cream
> or ring, which will prevent infection, while permitting conception ---
> the partner need not even know of its presence --- can save the lives of
> millions of women. The head of UNAIDS, Dr. Peter Piot, who will be known
> to many of you, recently suggested that the discovery of a microbicide
> may be only three to four years off. That's almost miraculous: short of
> a vaccine --- and we must never stop the indefatigable hunt for a
> vaccine --- a microbicide can transform the lives of women, and
> dramatically reduce their disproportionate vulnerability. What's needed
> is science and money. You can help with both.
>
> On the more fundamental front, I want to suggest that the process of UN
> reform, now urgently underway, be confronted with arguments that spare
> no impatience.
>
> I have heard the President of Botswana use the word extermination when
> he described what the country is battling. I have heard the Prime
> Minister of Lesotho use the word annihilation when he described what the
> country is battling. I sat with the President of Zambia and members of
> his cabinet not long ago, when he used the word holocaust to describe
> what the country is battling.
>
> The words are true; there's no hyperbole. The words apply,
> overwhelmingly, to women. That being the case, there has to be a
> proportionate response.. It seems to me that the response should proceed
> on two simultaneous fronts..
>
> First, let me say that I was thrilled by the suggestion from Mary
> Robinson, and others, that Penn State act as a kind of coordinator for
> the surprising numbers of initiatives, unrelated one to the other,
> occurring under the auspices of many universities. The practice of
> twinning, the practice of using various Faculties as training centres,
> the practice of American and Canadian universities bridging the gap in
> capacity until the developing country can take over . all of that is to
> the good, and it needs coordination. But there's more, I would submit,
> for you to do. Within multilateralism, that is within the UN system,
> wherein lies the best hope for leadership, there must be a change in the
> representation of women. There must emerge, for Women's Global Health,
> and certainly for HIV/AIDS, an agency, an organization, a powerful Think
> Tank, whatever the entity --- it can start on the outside, and then
> claim equal presence amongst the co-sponsors of UNAIDS, and thrust its
> advocacy upon the Secretariat, the Agencies, the member states, in
> unprecedented volume and urgency. Nor does this entity confine itself
> solely to women's global health, although that is the entry point. It
> insists on the 50% rule . just start your evidence-gathering by
> identifying the numbers of senior women, agency by agency, secretariat
> department by secretariat department, diplomatic mission by diplomatic
> mission, and when you've recovered from the shock of learning that the
> multilateral citadel knows nothing of affirmative action, then begin
> your unrelenting advocacy. This must become a movement for social
> change. It needs leadership. Why not this University, why not this
> conference? And let me emphasize; there's nothing limiting about this
> concept. We're looking towards the day when governments are finally made
> to understand that women constitute half of everything that affects
> humankind, and must therefore be engaged in absolutely everything. Why
> would it not be possible to build a movement, committed to the rights of
> women, in the first instance amongst nursing and medical faculties
> across the world, and take the world by storm? You have resources,
> knowledge and influence available to no others. The terrible problem is
> that you've never marshalled your collective capacities.
>
> Second, a similar movement must be directed, I would submit, to Africa
> itself. I'm hesitant here, because there are enough neo-colonial
> impulses around without my being presumptuous in making recommendations
> for Africa, and indeed for women. But I must bring myself to say what I
> know to be
> true:
> the African leadership, at the highest level, is not engaged when it
> comes to women's health. There's so much lip service; there's so much
> patronizing gobble-de-gook. The political leadership of Africa has to be
> lobbied with an almost maniacal intensity on the issues of this
> conference, or nothing will change for women.
>
> That, too, will take a monumental effort. In my fantasies, I see a group
> of African women, moving country to country, President to President,
> identifying violations of women's health specific to that country, and
> demanding a change so profound that it shakes to the root the gender
> relationships of the society. I know that African women leaders like
> Wangari Matthai and Graça Machel and many prominent cabinet ministers,
> committed activists and professionals think in those terms; what is
> needed is a massive outpouring of international support from their
> sisters and brothers on the planet.
>
> I'm 67 years old. I'm a man. I've spent time in politics, diplomacy and
> multilateralism. I know a little of how this man's world works, but I
> still find much of it inexplicable. I don't really care anymore about
> whom I might offend or what line I cross: that's what's useful about
> inching into one's dotage.
>
> I know only that this world is off its rocker when it comes to women. I
> must admit that I live in such a state of perpetual rage at what I see
> happening to women in the pandemic, that I would like to throttle those
> responsible, those who've waited so unendurably long to act, those who
> can find infinite resources for war but never sufficient resources to
> ameliorate the human condition.
>
> I'm excited of course about the Millennium Development Goals, and I'm
> equally excited that with the leadership of the British, this next G8
> Summit in the summer might just possibly spawn a breakthrough. And there
> are countless numbers of people working to that end.
>
> But I have to say that I can't get the images of women I've met,
> unbearably ill, out of my mind. And I don't have it in me either to
> forgive or to forget. I have it in me only to join with all of you in
> the greatest liberation struggle there is: the struggle on behalf of the
> women of the world.
>
>
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