Global Policy Forum

By Janet Fleischman and Kathleen Cravero*

International Women's Day, focusing this year on the plight of women and HIV/AIDS, carries special significance. In the worst-affected regions of sub-Saharan Africa, women and girls account for 58 percent of those living with HIV/AIDS, and girls age 15-19 are infected at rates four to seven times higher than boys, a disparity linked to sexual abuse, coercion, discrimination, and impoverishment.

The Bush administration's new five-year global HIV/AIDS strategy recognizes the urgent situation of women and girls, but much more is needed to translate this into action on the ground.

The US President's Emergency Plan for AIDS Relief is a historic initiative to support HIV/AIDS treatment, care, and prevention in 15 countries, largely in Africa. The new global AIDS coordinator, Ambassador Randall Tobias, consistently mentions the goals of treating 2 million HIV-positive individuals, preventing 7 million new infections, and caring for 10 million people. For these goals to be met, however, the United States will need to support proactive strategies to make women and girls a focal point for prevention and treatment. That women's subordinate status fuels the epidemic in acutely affected countries is increasingly accepted; the challenge now is to initiate innovative strategies that couple this knowledge with available resources as part of a comprehensive response.

Take for example the unprecedented new momentum to provide antiretroviral treatment, evident in international initiatives such as the US HIV/AIDS strategy and the World Health Organization's "3 by 5" campaign, which aims to have 3 million people on treatment by 2005. In sub-Saharan Africa alone, almost 4.5 million people need antiretrovirals, but a mere 100,000 now receive it.

Given that more than half of those living with HIV/AIDS are women, the new treatment programs should address the realities of abuse and discrimination that women and girls face: the lethal combination of long-standing barriers to health care, the new threats of violence and abandonment that often result when a woman discloses her HIV status, and the underlying violence and inequities that put women and girls at particular risk of HIV transmission. The rollout of treatment programs provides an opportunity to link prevention and treatment and to curb the disproportionate impact on women and girls.

AIDS is insidiously undermining the skills, experience, and networks that support women and their families in Africa and around the world. Women are clearly vulnerable, but they are not weak, evidenced by the fact that so many survive and become the leaders in organizing support and care for their families and communities. The point is to give them what they need to save themselves: resources, education, jobs, access to HIV treatment, legal support, and real options to live safely and productively. This is a critical moment for the United States and its international partners to develop proactive strategies that enable women and girls to have meaningful access to HIV prevention and treatment.

Understanding the epidemic's impact on women and girls leads to logical programmatic decisions:

- Design treatment programs to address the obstacles that women and girls face in accessing health care.

- Train health workers, law enforcement, and judicial personnel to recognize and act upon the signs of gender-based violence.

- Create environments in which women can safely seek information, testing, and treatment.

- Make condoms accessible, affordable, and acceptable.

- Expand prevention messages beyond "abstinence, be faithful, use condoms," which are often not in a woman's power to decide, especially for married women.

- Incorporate HIV/AIDS awareness and prevention information into school curriculums and keep girls in school.

- Provide women and girls with skills training and access to credit.

- Support legislative and judicial reform to repeal laws that violate women's rights.

- Establish gender advisory groups in the target countries, and include women's groups and networks of women living with AIDS.

- Intensify support for nongovernmental organizations that work to reduce women and girls' vulnerability to HIV/AIDS and expand community mobilization.

International Women's Day is a time to highlight the situation in which women live, and the AIDS crisis demands innovative efforts to change them for the better. The success of the Bush administration's HIV/AIDS initiative will depend on its ability to meet these challenges.

* Janet Fleischman is chairwoman of the gender committee of the Center for Strategic and International Studies' HIV/AIDS Task Force. Kathleen Cravero is deputy executive director of UNAIDS.