Global Policy Forum

Women and girls living with HIV/AIDS must have access to the antiretroviral medicines that will save their lives, the World Health Organization (WHO) said in a statement released on the even of the World AIDS Day. For this year's World AIDS Day, December 1, WHO is calling on countries to set specific national targets for treatment of women and girls and to take measures to ensure equitable access to AIDS prevention and treatment services.

Although 47% of people infected with HIV around the world are women and girls, there is currently no reliable information on how many of them receive treatment. Most countries collect general data on the number of people being treated, but this is generally not broken out by sex or by age. If countries are to ensure and monitor equitable access to treatment, they will need to collect data not only on who is becoming infected but also on how many men, women and children are getting access to prevention and treatment. "To ensure equitable access to prevention and treatment services for women and girls, it is important for countries to set their own national targets," said Dr LEE Jong-wook, WHO Director-General. "The targets must match the proportion of men, women and children who are living with HIV and in need of treatment."

WHO is also highlighting the need to address violence against women and girls as an integral part of the response to the AIDS epidemic. Violence against women is widespread. Estimates suggest that between one in three and one in five women globally have been physically and sexually assaulted by intimate partners in their lifetime. Studies from Rwanda, South Africa and the United Republic of Tanzania show up to three-fold increases in risk of HIV among women who have experienced violence compared to those who have not. Studies also suggest that for many young women, the first sexual encounter is coerced or unwanted. The risk of HIV transmission increases when sex is forced, especially for girls and young women because their vaginal tracts are immature and tear easily.

"Violence against women can not be tolerated at any level," said Dr Peter Piot, UNAIDS Executive Director. "The fear of violence prevents many women from accessing HIV information, from getting testing and seeking treatment. If we want to get ahead of the epidemic we must put women at the heart of the AIDS response."

Violence against women and girls in its different forms increases women's vulnerability to HIV infection and undermines AIDS control efforts. For millions of women, violence and the fear of violence is a daily reality and increasingly, so is AIDS. Women in every culture around the world face violence, most often at the hands of their partners and within the so-called safety of their homes and families.

"If we are to succeed in addressing two of the most critical public health problems facing us today - violence against women and the AIDS pandemic - it is also essential to challenge social norms which condone and even promote violence against women. This includes male behaviours which put themselves, their partners and children at risk of HIV infection," said Joy Phumaphi, Assistant Director-General of Family and Community Health.

To ensure equitable access for women and girls, countries need to address barriers preventing the access of women and girls to AIDS treatment and care, such as transport and distance, opening hours and waiting time in clinics. The integration of HIV/AIDS services with sexual and reproductive health services, such as family planning and antenatal care, can also help address women's different needs and reduce stigma.

Programmes must take into account how drug costs, user fees or cost-recovery mechanisms might adversely affect women. In many countries, women lack equal access to both money and the opportunity to earn it. This frequently prevents them from getting access to treatment. Therefore free provision of antiretrovirals at the point of service may result in a greater number of women starting on treatment programmes and improved rates of adherence to treatment. Women will particularly benefit from such approaches as they have less time, mobility and resources to access separate services.

WHO and UNAIDS are on World AIDS Day issuing two documents aimed at ensuring equitable access to antiretroviral treatment for potentially underserved, vulnerable and marginalized groups, including women. The first is a policy brief outlining key issues that affect women's access to HIV treatment and care and identifies actions to address the impact of gender inequality on women's use of HIV services. The second, "Guidance on Ethics and Equitable Access to HIV Treatment and Care", explains how ethical analysis, using the principles of utility, efficiency and fairness, can help policy- makers assess the various possibilities and consequences of their choices. The document also stresses the importance of involving all stakeholders in an open and accountable process of planning services and prioritizing groups for treatment.

As treatment programmes are implemented, monitoring is important to identify who is getting access to treatment, who is not and why, and how this can be corrected. Unless women and girls become the key focus of prevention, treatment and care programmes, addressing the AIDS pandemic will remain a considerable challenge in large parts of the world.

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