CSW 2009

After almost two weeks of round-table discussions, panel debates and lobbying, the 53rd session of the Commission on the Status of Women (CSW) came to an end, its legacy being the statement of 'Agreed Conclusions' focusing on this year's priority areas, including the "equal sharing of responsibilities between women and men, including caregiving in the context of HIV/AIDS".

A helpful summary of the final proceedings of the commission, which gives a good overview of the key areas of debate and the content of the Agreed Conclusions can be found on the UN website. Find also on the website the advanced, unedited version of the Conclusions. (Note that final and agreed Conclusions will be available at the end of June in the CSW report.) 

After eight days  and evenings of effort, meetings, draftings, lobbying, talking, to all and sundry (Senior UN officials, government, NGOs) at the 53rd Session of the CSW and a fortune spent on getting to New York and paying for our incredibly overpriced hotel beds ( as the £ dived)  in order to get WIDOWS and WIDOWHOOD at least referenced in the Agreed Conclusions on the priority theme " Equal Sharing of Responsibilities between women and men, including care-giving in the context of HIV/AIDS", today I am gob smacked by our defeat. 

The "widow" word is barely there.  How incomprehensible, scandalous and stupid.

It's well known by now that across the developing world in general and in conflict affected countries in particular, widows are systematically targeted for rape and worse,deliberately or recklessly infected with the HIV virus, and, as widows, mostly evicted from their homes, deprived of inheritance, land and property. They are often the sole carers of children, other orphans, sick, wounded, elderly and traumatised.  Key providers in their communities. Yet their poverty and their crucial roles go unaddressed, either by the UN, the donors, or governments.

Below is our modest proposed addition to the Agreed Conclusions, totally supported, I am proud to say, by our own UK delegation to the CSW and indeed by the UK mission to the UN who had sent it on to the EU (European Union) group. We had to make an addition, not an amendment, since there was no where in the draft document that gave us an opening for an insertion... 

"CONDUCT RESEARCH AND IDENTIFY THE GLOBAL DEMOGRAPHIC PROFILE AND THE SPECIAL NEEDS AND ROLES OF WIDOWS OF ALL AGES AS CAREGIVERS IN THE CONTEXT OF THE  HIV/AIDS PANDEMIC IN ORDER TO, INTER ALIA, PROTECT THEM FROM DISCRIMINATION, VIOLENCE, HARMFUL TRADITIONAL PRACTICES, AND ENSURE THEIR RIGHTS TO INHERITANCE, LAND AND ACCESS TO BOTH THEIR HUMAN RIGHTS AND EQUAL PARTICIPATIPN IN PEACE BUILDING, RECONCILIATION AND RECONSTRUCTION ACTIVITIES"

But we were up against powerful rivals with strong caucuses and global support: children and the "older women". We could not join up with the latter, for we needed to dispel the myth that widows are "old". Many are young and may still be children - child brides for widowers whose wives have died from AIDS. When will the international community get to understand that behind the mass of impoverished hungry homeless children, there are widowed mothers? If their needs and roles are not addressed, there is no hope for reducing child poverty, getting children into education or achieving any of the Millennium Development Goals 

Great if that had gone in. Who could object?  But it was not to be. Alas, we did not have a "caucus" like the girl child, youth and the older women caucuses that bring lots of different lobbying NGO groups together.  Next year if I can ever bear (or afford to return) we will have set one up: Widowsaction.caucus and maybe we will be more powerful and effective as we get more support from NGOs from all the different regions.

Activities and campaigns focusing on children always win hearts and therefore money.  Raising support and funding to get widows' voices heard, and widow's roles acknowledged and supported is, by comparison, a bitter and thankless task. Ministries of Women, in developing countries, most with derisory funding, rarely have the capacity to address the status of widows, let alone count how many their country is host to. (See Iraqi Minister for Women's Resignation speech in February when she spoke of the "army of widows" her department was unable to help)

Never mind that never before in human history has there been such an explosion in the numbers of widows, children, young women, and the elderly - and that these are the poorest, most stigmatised and marginalised women in the world, no one really wants to know. At least our UK delegation listened to us and backed us.  

Today, to my intense disappointment, I opened my laptop and used the "find" key.  One pathetic mention that gives no impression or information on the appalling situation of widows in the context of HIV/AIDS, conflict, poverty, violence and stigma. Widows in this setting, especially if they are older women, are often accused of being "witches"; many are beaten and killed. Yet they are the people solely responsible for raising the next generation, finding shelter, food, water, and safety. Why on earth are the Member States so blind, so hopeless, so unimaginative and uncreative?

This is what we got in the Agreed Conclusions for all our efforts:

"Develop multi sectoral policies and programs and identify, strengthen and take all necessary measures to address the needs of women and girls, including older women and widows, infected with or affected by HIV/AIDS, and those providing unpaid care giving, especially women and girls heading households, for, inter alia, social and legal protection, increased access to financial and economic resources including micro-credit and sustainable economic opportunities, education including opportunities to continue education, as well as access to health services, including affordable antiretroviral treatment, and nutritional support".

Hopeless. Ineffective. Should I be over the moon for having spent £1,500 being in New York to get just this tiny mention? 

And now they've decided that the 54th CSW will be on "implementation of the Beijing PFA"    What? All over again? The 12 action areas which have never, in 14 years, been implemented?   See what I mean. Why come back next year? ...and yet and yet....just the carrot of that tiny word appearing in a document pulls, attracts, seduces.....................

On Thursday March 12, I had the pleasure of speaking on a panel sponsored by the United Nations Association - USA at the Commission on the Status of Women (CSW).  The topic, addressing the care-giving burdens and gender gaps in PEPFAR, seems as timely as ever as the Obama Administration has found itself dealing with the results of the Emergency Plan's reauthorization process and seeking new leadership at the Office of the Global AIDS Coordinator (OGAC).  While PEPFAR has made great progress in addressing the treatment needs of millions living with HIV and AIDS in the developing world, we know very little about the impact of PEPFAR's prevention programs on populations at greatest risk for infection.  And with new global AIDS law maintaining an emphasis on abstinence and fidelity in prevention programs, addressing the care-giving burdens and closing the gender gaps in the Emergency Plan will continue to pose a challenge to implementers on the ground. 

Women account for half of all adults living with HIV and AIDS worldwide, and rates among young women are growing steadily.  OGAC has responded to the need to address HIV among women and girls by integrating gender strategies into its care, treatment, and prevention programs.  The implementation of the strategies is monitored by a gender technical working group, comprised of key staff of the various U.S. government agencies tasked with implementing PEPFAR programs.  OGAC has been consistent in reporting on "gender-sensitive" activities since 2005, and reported spending $1 billion on these efforts in 2008.  However, because prevention policies fail to meet the needs of women, these strategies are missing the mark at adequately addressing the AIDS pandemic among the female population. 

The fight for better prevention policy for U.S. global AIDS programs was lost in the reauthorization process last year.  Three key aspects of the law will have a direct and almost immediate negative impact on women in need of prevention and care services.  The first is the "balanced funding requirement," which stipulates that if less than 50% of funds for the sexual transmission of HIV is spent on abstinence and fidelity programs, the Global AIDS Coordinator must issue a report to Congress.  The second is the retention of the Anti-Prostitution Loyalty Oath, also known as the prostitution pledge, which requires NGOs and service-providers receiving aid through the Emergency Plan to sign an oath opposing prostitution and sex-trafficking.  The third is that the bill fell short by neglecting to commit U.S. global AIDS policy to integrate family planning services and HIV/AIDS services, although nothing in the legislation precludes the integration of these services. 

The lack in adequately addressing the prevention of the sexual transmission of HIV among women and girls undermines all gender strategies implemented in PEPFAR programs.  The fact that most women and young women are contracting HIV within marriage or primary partnerships is a clear sign that focusing on abstinence and fidelity does nothing to empower them in protecting themselves.  In environments where male dominance and female inferiority prevail, innovative strategies for prevention that provide women and young women with the tools required to protect themselves need to be emphasized and implemented broadly.  The prostitution pledge, which has become a political football used by conservatives to demonize women and young women engaged in the sex sector, has done nothing but stigmatize an already marginalized population and has also caused a number of organizations whose aim is to meet the prevention and care needs of this population to curtail their services.  The lack of family planning/HIV integration that is broad and widespread enough to truly impact women and girls will only continue to overburden the health systems and health infrastructures that are already experiencing shortages and pitfalls.  Further, the inconvenience for women and young women living within resource-constrained settings forced to visit multiple providers for health care services related to the reproductive system makes no sense for the largest international health program in history. 

If the U.S. government is serious about addressing the gender implications of HIV and AIDS among women and young women, it must make prevention a priority in PEPFAR.  Adequately addressing the care-giving burdens and gender gaps of the AIDS pandemic depends on it.  UNAIDS executive director Michel Sidebé echoed these sentiments in his speech at the CSW and called for new paradigms in gender inequality for women: "...give women and girls the power to protect themselves from HIV...This requires investment in universal access to comprehensive sexual and reproductive health services."                      

"Issues of gender equality have international attention and even the possibility of resources- but do we (the UN Interagency and NGO community) have the crucial infrastructure and capacity to manage that? And in the case that we are simply creating that capacity as we go along- are we doing so effectively?"

Going into my first CSW I posed the above questions to myself, it was quite auspicious to think that I might be closer to an answer after two weeks of meetings on a wide variety of subjects effecting women all over the world. I will do my best, to give those findings I did gather, as well as some unexpected lessons learned as well.

Much of my work this week focused on the need for greater data collection and analysis at the UN. This universal goal is applicable to all the priority themes: HIV AIDs, Gender Based Violence and Economic Empowerment. We have in fact reached a crucial turning point where our research has furthered the impact of our advocacy work. The only way to continue to benefit from these gains is institutionalize and build continuity and capacity for research as a priority.  One way I suggested doing this is to engage with key external partners to build such capacity (including the results based initiatives projects.)  Sharing resources for continual research and development will strengthen the knowledge community, and allow all programs to grow in influence.

Another innovative solution I addressed is the GEAR project. However, I was surprised as I met with my colleagues within the UN system how few of them are aware of the exact tenants and goals of the project. I believe this originates from the fact that GEAR has done most of its development within the member state community.  The fact that the UN is a conglomeration of member states, this strategy does make sense, however it alone will not suffice. Should the GEAR project gamer success, it will have to align itself with the relevant UN agencies. I think that there is a bit of nervousness about coming together with the very agencies you want to reform (in some cases make obsolete) but it makes perfect sense. These agencies have the knowledge, resources and best practices that are necessary to creating a new gender apparatus. Without unity on this effort, it will fail.

The problems that divide the UN Gender apparatus (and UN writ large) are continually spilling in to the NGO community as well. This is perhaps even more distressful. Regional and thematic NGOs benefit if they address the issue de jour, and are quickly forgotten when the debate moves on to another hot topic. The competition for what are incredibly limited resources is NGO infighting and competition. Collaboration and coordination remain in short supply. For instance, the secretary generals campaign to UNITE against gender based violence may move us together for this goal- prioritizing those communities that work on the topic- while completely forfeiting relationships with NGOS that focus on other vital subjects. And what about that nexus where the NGO and UN community meet? Well my friends, it doesn't really exist- at least in my short experience- UN meetings and NGO meetings remained separated. In choosing future priority themes I look forward to a discussion of unification of efforts, an issue of desperation, not necessitation.

Having studied various women movements from all over the world, including the Balkans, Israel and the Palestinian Territories, and Iraq I have found that advocacy is most successful when common bonds are forged which turn the narratives of division on their head. It has been achieved under the most difficult and violent of circumstances- illustrated through women standing hand in hand with their supposed enemy along dividing lines in their community. Shouldn't we expect no less from ourselves- in the calm and relative ease of the developed world to come together across resource and bureaucratic divides? We should expect more, require more, and act in the process of achieving more. Any less will be our downfall.

After a decade of participating in civil society organizing around the Commission on the Status of Women, I came to this year's meetings to observe.   It's an exciting moment for those of us who have worked for so many years to link the women's movement with the HIV and AIDS movement.  For the first time, a central aspect of HIV and AIDS affecting women - the burden of care - is an explicit focus of the Commission on the Status of Women.  Further, the new Executive Director of UNAIDS - Michel Sidibe - made an impassioned speech at the opening of the CSW entitled "AIDS and gender equality: time for new paradigms."

Mr. Sidibe spoke with force about the issues that women's rights advocates had been pressing for heightened attention to in the AIDS response for decades: gender-based discrimination; sexual violence; rape as a tool of war; the need for a social revolution; comprehensive sexual and reproductive health services; universal access to sexuality education; greater female-controlled prevention methods, including the female condom; and the "democratization of problem-solving."  I leapt out of my seat after reading the text of this barrier breaking speech - and said yes in response to his call, "let us further unite the tremendous power of the women's movement with the AIDS movement."

The sessions organized by colleagues at this year's CSW matched the tone and tenor of Mr. Sidibe's speech.  These sessions shone a light on the sexual and reproductive health and rights of women living with HIV; on the need for new frameworks in the women's rights movement - such as one of reproductive justice to expand the historic category of reproductive choice; of feminist men mapping out the role and the means for men and boys to engage gender equality; on the human rights implications of current approaches to the prevention of parent to child HIV transmission; and the avenues for expanding access to family planning and HIV prevention tools, such as the female and male condom.

So I arrived at this year's CSW expecting the hustle and bustle to which I have grown accustomed of familiar faces, passionate debates, and powerful women.  And while extraordinary women are here in abundance, I found myself surprised by the lack of electricity in the air.  Granted, I am reflecting on one morning's experience of the CSW (at the start of the second week when the momentum hits a low.)  However, I found it telling that the first three sessions I attempted to attend had dissolved or were cancelled because no speakers showed or the organizers had failed to arrive.  When I finally stumbled upon a remarkable discussion in the Church Center (the aging building with rattling elevators where non-governmental organizations are provided space to convene forums), I was one among a handful of attendants.  And at 36, I expect I was the youngest woman in the room as well.  In that very same room four years ago, during a parallel event on a related topic, there was not a seat to be had and no place even to stand. 

So the question I ask is what are we doing here?  Who is listening?  What is being heard?  Are we inspiring the next generation of young women to share in and lead the work toward gender equality?  Are we engaging men?  Has our work evolved?  Have our discussions changed?  How do we maintain the relevance of the Commission on the Status of Women in a world in warp speed?  How do we sustain movements in a moment where the economic crises overshadow all?  How do we bring new voices, energy, and vision to the task when the leaders who were at the vanguards of the movement decades ago resist?  How do we create room for broader, more diverse alliances and new directions?

While I am heartened to see the passion and conviction which Mr. Sidibe brought to his speech and of the Obama Administration to women's human rights, I worry that the frameworks of Beijing and Cairo now feel like ancient history in a fast-moving world.  I worry that at this year's Commission on the Status of Women I did not see extraordinary HIV positive women leaders speaking with their own voice.  I worry that we, as women's rights advocates wherever our focus might be - reproductive rights, land rights, sexual rights, education rights, livelihood rights - have not opened the doors of the CSW to a broader cross-section of stakeholders and that we have failed to engage young people so that the heart and soul of the movement rests in those of us who have been around this block before.  So the challenge I take from the 53^rd Session of the Commission on the Status of Women is that we need to get back into the streets, reach out our hands, and reclaim our roar before we fade into irrelevance having the same conversation in the same dingy room with the same folks with whom we have grown comfortable speaking.

If there is such a thing as ‘choreographed chaos', it's been happening here at the CSW  for the past two weeks in the Vienna café in the UN.

Now in Washington DC, am trying to recover from last week's circus at the UN.. Rethinking surviving that first week of the 53^rd session of the UN CSW, I have changed my mind. I am now, for probably the first time in the 11 years since I've been coming to New York, glad I made it there.

Our own event on ROLES AND NEEDS OF WIDOWS as caregivers in context of HIV/AIDS conflict, violence and poverty was good, though we were given the worst "slot", 6 pm in the evening, so none of the UK based NGOs nor the official delegation came as they were all at the UK Mission discussing the GEAR  (Gender Reform in UN architecture, or something like that).

Insanely,  various very high level international luminaries working on gender issues, such as Rachel Mayanja, the Special Adviser to the UN-S-G on gender issues, and the Gender Adviser from the Commonwealth Secretariat (who had originally said they would be there and speaking) were all away in Liberia. Maddeningly, at the very same time that the CSW held its annual session, a high level conference was taking place in Monrovia on women, leadership and political participation in peace building, hosted by President Ellen Sirleaf Johnson.  Couldn't they have chosen another date?

However, we had fantastic panellists from DRC, Uganda, South Africa, Nepal and Nigeria, and India, whose descriptions of the situation of widows brought tears to the eyes of many of those attending. And we came up with some great recommendations. It's time for the UN to commission a special report on widowhood just as it did on children in conflict. It's time for the appointment of a UN Special Rapporteur on this neglected subject and for an international conference. It's time that CEDAW develop a questionnaire to be sent to all member states to provide statistics on the status of widows and it's time to mainstream widowhood issues in all relevant decision making.  What richness of experiences and ideas were presented in these NGO fringe meetings. But how boring, by comparison, were the speeches by governments.

The few occasions I decided to sit through the official proceedings were not only boring but often actually misrepresentative of the situation of women in their countries. The whole CSW experience is stressful, rushed, and chaotic as we NGO women rush from one fringe event to the next - in and out of Church Centre - but looking back it's the contacts made, the new opportunities that open up, the fresh perspectives that appear, and most important, the encouragement and support of certain people - some influential and important in the UN and government, and others, movingly, who come from the real grass-roots realities in villages, barrios, and Refugee IDP camps that inspire us to carry on..

It is a fact that we Brits are particularly favoured, for we, I think uniquely, do have a relationship with both our official UK delegation and with the FCO, through the UK mission to the UN. Sir John Sawer, our ambassador, and his staff listen to us. We are, I think, the only NGO lot that actually meets with the delegation and with our Mission on a daily basis, so we get to know what is going on (if we can understand the complexities of the diplomacy in the "closed negotiating sessions" as government officials debate long into the night whether to exchange a "for example", for an "including", or change a full stop to a semi-colon). We persevere and lobby, propose and argue, and maybe we do in some small away begin to chip away at dyed-in-the-wool attitudes of FCO staff.

On the neglected widowhood issues ( the word "widow" barely ever appears in any of these UN documents, neither in the CEDAW, the BPFA, or the present draft conclusions on the priority theme " Equal Responsibilities for care giving in the context of HIV/AIDS".  

Given the vast uncounted numbers of widows affected by the pandemic in so many ways (stigma as well as poverty) we at WPD have been plugging away to get in an additional paragraph on widowhood into the draft.  Just a few hours ago I heard from our UK Women's National Commission that they were trying, on our behalf, because it looks as if "disabled women" will get in, to join with the references to "the girl child heading households", and possibly "older women".  If they fail to include widowhood, it would be scandalously insulting to the millions of widows who as grandmothers, young mothers, and child widows are caring, although many are sick themselves, with those affected by the virus, and yet because of extreme discrimination and harmful traditional practices, are often left without homes, land, or any rights to inheritance...while expected to raise and educate and feed the next generation.

Yes, one gets angry with the millions spent on this two-week session, as government officials dance upon pinheads, and many of us from the NGOs are often totally confused by the very language and the descriptions of these mystical negotiations that often continue into the small hours, yet seem to have little relevance to the mass of women who should be benefiting from these deliberations. 

Every one of the hundreds and hundreds of women who are here at the CSW is trying to build a ‘common understanding', by accurately describing the daily lived reality in their country or region.

The World Bank

In my earlier posts I have discussed my fundamental issues with the amount of data collection and systematic information gathering that goes on at the UN. As a solution, I recommended that the UN work in coordination with varied partners to advance their own capacity for measuring success at gender equality. It turns out one such project is underway right under my nose- and I wanted to bring it to the forefront of your attention as well.

Operating under the proven fact that empowering women through economy brings stability, prosperity and development to a nation, the World Bank Group, the OECD, UNIFEM and the International Center for Research on Women have launched a series of five community-level interventions (termed results-based initiatives or RBIs) in Liberia, Kenya, Egypt, Laos and Afghanistan. They discussed the RBIs and their respective projects in a CSW forum entitled "Gender Equality and Women's Economic Empowerment." There are two primary things that make the RBIs a very novel approach to engendering development projects. The first is that is that the RBIs will focus on including quality measures of gender impact at the outset through incremental documentation and performance and rigorous evaluation of findings. Secondly, under the recognition that gender equity is a multi-level and multi-dimensional issue, RBIs work across sectors on the Micro (individual and household) and Meso (community) levels to make a difference at the Macro (national) level.

In support of the RBIs the aforementioned organizations are also working to effectively facilitate better development funding of gender issues through creative fiscal incentives for such. The case for incentives based programming is that it succeeds where mandates for action have failed. That is, simply requiring gender equity through policy has not proven successful in the long term- however, rewarding gender equality programming through fiscal incentives motivates action. At the Bank such incentives are operationalized in an action plan that includes better institutional collaboration and donor networks, coordination between foreign sector leaders to expand private sector development and ranking that is doing the best business for women. The project is likely to succeed where others have failed, as high profile examples (including the Adolescent Girls Initiative) have garnered both attention and resources (two crucial pieces of the formula for success).

Incentives are key. The program reminded me of a case study I worked on as part of a larger study of women and nation building in Afghanistan: the National Solidarity Project, a World Bank funded program that distributes resources to communities that met the prerequisites of development projects that included the presence of women. With its explicit gender-related goals and the visible presence of foreign implementers, this program could be expected to generate resistance. But the experience of the NGOs who implemented this program shows that while it was not necessarily easy to obtain the participation of women, it was not in any instance a "deal-breaker" or even a major source of discord. Rather, an ongoing interactive process in which obstacles and local concerns were continuously met with discourse and novel solutions garnered local support.

Incentives like those offered in RBI projects can be very useful and powerful in even the most precarious of circumstances. The contribution they could make towards advancing gender equity through reliable data is a very exciting development, especially in moving forward toward the Millennium Development Goals.

Have we achieved the equal participation of women and men in decision-making processes at all levels? Having recently undertaken a review of women's leadership and participation in the AIDS response for UNIFEM, I have been intensely immersed in answering this question and understanding where we stand on the trajectory for the past two years. And now reflecting on this year's Commission on the Status of Women, I sadly find that we are far from the mark.

Despite clear calls for women's participation in decision-making and the increased attention to and resources allocated for HIV and AIDS, as well as heightened debate around the "feminization" of the epidemic, women's full participation in the AIDS response has still not been realized. A rapid scan of available data on participation, suggests that there is no decision-making mechanism in the AIDS response where the numbers of women equal the numbers of men around the table. And when women do obtain a ‘seat at the table', we are brought in only to speak to ‘women's issues'. Further, the women who are the most affected by the epidemic, have a longer road to travel and are frequently only invited to the ‘table' after agendas have been set or policy decisions taken.

How is this so? How can we be at the 53^rd Commission on the Status of Women and still stand outside so many decision-making forums? How is it that we're still talking to each other in the hallways and on the sidelines? How is it that our debates are not directly shaping the flow of funds or the development of programs?

The reasons do not make for a sexy sound-bite or an easy answer. One session I attended yesterday on the interrelationship between land rights, food security, HIV and AIDS, and poverty outlined how women are shouldering the burden of caring for and feeding their families without land ownership. If women don't have food to eat or food to feed their families, how can they participate in these global processes which shape policies, programs, and funding streams?

In a different session, Dazon Dixon Diallo of SisterLove in the United States spoke about setting out to understand why black women were kept from participating in the reproductive rights movement - and set forth how the framework of reproductive choice was too narrow a one for women in whose lives the human right to decide if and when to have a baby, the conditions under which to have that baby, the decision to terminate the pregnancy, and the right to parent the children they already had were first and foremost. In interrogating sexual and reproductive rights and health for women of color, Delphine Serumaga of POWA in South Africa set forward the organization's starting point of understanding women's rights to be framed by and determined by patriarchy.

This is all to set forward that not only have we as a global community and a global movement failed to seriously address and advance the conditions of women's lives and women's access to resources, including land rights, that constrain women's participation in decision-making, but that we have also created movements in our own midst that do not make room for our diversity so that we may find a common ground. So not only has there been a failure by the state to meet obligations to advance women's rights, there is also ‘blame' that we share for failing to reach our hands across movements, across our regional, racial, sexual, or socio-economic divide to find a way forward together.

It is my hope that the seeds diverse stakeholders in the gender, human rights, sexual and reproductive health, and HIV communities have planted together through ATHENA can blossom into a bigger tent, a more robust voice, and new tables where women sit as true equals with men. 

A cruel paradox has been emerging during a number of Commission on the Status of Women (CSW) panels: while women bear the lion's share of care giving responsibilities within the HIV/AIDS pandemic, they are often unable to protect their own sexual and reproductive health and rights. Discriminatory and violent practices in health care facilities combined with dangerous legislative trends, are leading to gross violations of the reproductive rights of women living with HIV. (See also: Sylvia Rowley's earlier blog on Uganda's harmful new HIV law and Kimberly Whipkey's blog on the coercive sterilization of HIV-positive women.)

HIV-positive women face myriad forms of discrimination and violence in health care settings, such as coercive sterilization and delays in and denial of reproductive health care services. At a March 4 panel hosted by the Center for Reproductive Rights, Ending Abuse and Neglect: Accountability Strategies to Protect the Rights of Women living with HIV/AIDS, various organizations shared the strategies and challenges faced to ensure the protection of the reproductive rights of women living with HIV. Esther Sheenama of AWOMI recounted being sterilized in Namibia at age seventeen without her knowledge and consent because of her HIV status. She bore witness to the stigma attached to women with HIV, the presumption that contraction of HIV terminates one's sexuality, and the anguish associated with a doctor unilaterally terminating her reproductive capacity. Vasili Deliyanis of Vivo Positivo described legal efforts to stop the widespread practice of coercive sterilization of HIV-positive women in Chile, including bringing a groundbreaking case with the Center for Reproductive Rights to the Inter-American Commission on Human Rights. Maria de Bruyn of Ipas reminded attendees of the devastating example of a woman in Kolkata, India, who was forced to terminate her own pregnancy because health care staff refused to touch her due to her HIV status. The panel also provided the opportunity to launch a joint report by FIDA Kenya and the Center for Reproductive Rights - At Risk: Violations of the Rights of HIV-Positive Women in Kenya - which documents the coerced HIV testing, violations of confidentiality, and verbal abuse and neglect encountered by HIV-positive women seeking reproductive health services.

Exacerbating human rights violations faced by women in health care settings are disturbing legislative trends of criminalizing HIV exposure and transmission. Such criminalization further compromises women's rights and impacts on women's ability to care for themselves and others - without taking into account women's realities and vulnerabilities, including their vulnerability to violence, abuse and further stigmatization. These laws, often overly broad and poorly drafted, could penalize individuals who practice safer sex and/or disclose their HIV status to their sexual partners, or mothers who transmit HIV to their children, either in utero or during labour and delivery. Pregnant women may face the most severe consequences of these laws, especially considering simultaneous trends of routine and mandatory HIV testing of pregnant women. One attendee at the panel described the terrible dilemma of pregnant women in some African countries who face mandatory testing when they seek pre-natal care and the risk of often lethal violence from their partners when their status is disclosed. It is, she said, as if there is a "lion at their door".

In recognition of the many threats to the reproductive rights of women living with HIV, the oral submission by the Center for Reproductive Rights and the ATHENA Network asks the CSW to call upon governments in its 2009 outcome document to protect the sexual and reproductive health and rights of women living with HIV by:

1) Ensuring that the protection of women's rights, especially the rights to autonomy, sexual and reproductive choice, equality and non-discrimination, are at the center of the response to HIV and AIDS - so as to guarantee that women's risks and vulnerabilities are not perpetuated, but rather addressed and minimized.

2) Taking pro-active steps to reduce discrimination against HIV-positive women in health care settings, with a particular emphasis on stopping non-consensual HIV testing and disclosure of HIV status, reducing stigma that leads to denial of necessary reproductive health services, and eradicating the reprehensible practice of coercive sterilization of HIV-positive women.

3) Passing legislation and policies that require medical providers to obtain informed consent prior to HIV testing and disclosure of HIV status, impose strict confidentiality standards in the context of HIV, and create effective enforcement mechanisms to guarantee these protections.

4) Ensuring that HIV legislation and policies focus on protecting the human rights of those living with HIV and the development of comprehensive and evidence-based prevention methods, rather than introducing provisions such as criminalization of transmission which increase women's risks and vulnerabilities.

I really am honored that an international audience, interested in the global perspective of gender and women's issues, reads this blog. But I would like to set aside a few words for the brave women in my own country, the USA, who face violence on a daily basis.

Last week, I was quite inspired to hear Ban Ki Moon address the plenary on the topic of violence against women. Moon, who is responsible for the UNiTE Campaign to End Violence Against Women told the gathered members of the CSW that "violence against women is an abomination. I'd like to call it a crime against humanity." It is this sort of high-level attention and dedication of resources that are key to moving violence against women to the forefront of international issues.

I left the session enthusiastic and excited to be a part of global change. Over the weekend I was reflecting on my excitement with a good friend who remarked, "yes, but for all of our change abroad, it's much too bad we cannot make a change here in our own country." She referred me to a film she had just seen on sex trafficking in New York entitled Very Young Girls. I knew that the issue of sex trafficking in the States is a serious one, and a bit more research brought me to some shocking statistics. The U.S. Justice Department found that 1,200 alleged incidents of human trafficking were reported in the U.S. over the 21-month period from January 2007 to September 2008, 90 percent of which involved females and 63 percent U.S. citizens.

Of course, trafficking is not the only (nor the most prevalent) way women in the U.S. experience violence- the recent high profile abuse and battery of famous pop star Rhianna has brought the issue of rampant intimate partner abuse to light.  Even more distressful is the rise and tolerance for partner violence in a younger population of women. A recent study by the American Bar Association about the pervasiveness of ‘dating violence' within the teen population revealed that 1 in 5 teenagers in a serious relationship reports having been hit, slapped, or pushed by a partner- the numbers are much higher (3 of 5) for verbal and mental abuse. Uncovering these statistics I suddenly felt a bit silly about my time spent uncovering abuse rates in the DRC- while totally ignoring the plight of my fellow citizens.

Special Rapporteur on Sexual Violence Yakin Erturk commented earlier in the week, that it is not nationalized culture that is responsible for gender-based violence (an excuse she hears regularly) but instead a global patriarchal culture. She is completely right- and we have a large case of that patriarchy here in the states as well.  This must be addressed from a policy standpoint- including through legal statutes, such as the Senate Bill for "Improving Assistance To Domestic And Sexual Violence Victims Act Of 2009". Secondly, civil society must continue to investigate and advocate for the needs of those in our own community in ways that fit that community. I am reminded of a presentation I saw early on in the CSW by UNIFEM Australia, on their very successful White Ribbon Campaign, which involves men in the fight against gender based violence in a very relevant and systematic manner. Advancing the causes of women in our own communities, through like programming will contribute to a greater sense of international equity and dignity for women as a global collective.

Late last year the AIDS activist community breathed a collective sigh of relief when Manto Tshabalala-Msimang was shifted from her position as Minister of Health into the low-profile Minister in the Presidency responsible for overseeing the Office on the Status of Women, the Office on the Child and the Office on Disability.

For eight years she obfuscated about whether HIV caused AIDS, insisted that anti-retroviral treatment was toxic and that AIDS treatment advocacy organizations were dupes of international pharmaceutical associations. She made repeated pronouncements that garlic, beetroot and olive oil were the best way to strengthen the immune system despite abundant evidence that anti-retroviral treatment is safe and effective and that alternative remedies are not sufficient to halt the spread of the virus. To add insult to injury, she collaborated frequently with peddlers of unproven and often expensive "alternative remedies" and granted them national prominence and legitimacy. The Journal of AIDS recently argued that her department's failures to implement effective treatment strategies cost 330,000 people their lives.

This year, the 53^rd session of the annual United Nations Commission on the Status of Women focused on "the equal sharing of responsibilities between women and men, including caregiving in the context of HIV and AIDS".

Tshabalala-Msimang's statements as the head of the South African Delegation to the CSW have brought into stark relief just how shortsighted we were in quietly accepting her appointment as the Minister in charge of the Office on the Status of Women.

The South African delegation arrived in New York with its work cut out for it. The 2007-2011 National Strategic Plan on HIV and AIDS (which civil society and allies within the Department of Health were able to push through while the Minister was in hospital receiving a liver transplant), sets clear and ambitious prevention and treatment goals aimed at reducing the care burden. The NSP commits government to 1) "reducing the number of new HIV infections by 50%" and 2) reducing "HIV and AIDS morbidity and mortality as well as its socioeconomic impacts by providing appropriate packages of treatment, care and support to 80% of HIV positive people and their families by 2011". The NSP also resolves to "recruit and train new community care givers, with emphasis on men", and sets a numeric target of increasing men's involvement by 20% by 2011.

Despite the ambitious targets set in the NSP, both the treatment backlog and the burden of AIDS care continue to grow. According to a report released in October of 2008 by the South African National AIDS Council "there has been an 87% rise in the number of deaths reported between 1997 and 2005 and deaths among those aged 25-49 has risen by 169%, surging from contributing 30% of all deaths in 1997 to 42% by 2005.  This can only be explained by the HIV epidemic." The document also reports that only 28 percent of people who need access to treatment currently have it and this, the report points out, is "below the global average for low- and middle-income countries". The report also argues that "from a national perspective, South Africa has largely failed in the prevention of mother to child transmission (PMTCT) of HIV due to the very uneven access women enjoy to both HIV testing and to the PMTCT services that should follow ."  At the end of February 2009, the province of the Free State had stopped enrolling new patients on treatment due to a stock-out of ARVs with predictable consequences on those providing AIDS related care and support.

Instead of using the CSW as an opportunity to find solutions to these problems, Minister Tshabalala-Msimang has instead used every opportunity she has had to resurrect her now thoroughly discredited positions on treatment toxicity, "pharmacovigilance" and "alternative remedies".

In response to this, Sonke has issued a press release calling on the South African government to clarify its position on treatment roll-out and explain why a senior representative of the government continues to distract from the real issues at hand. In the press statement we have also urged government to negotiate for CSW conclusions and recommendations that make clear its commitment to the goals articulated in the NSP and that focus on three priority areas: 1) strengthening the capacity of the health sector; 2) implementing effective HIV prevention and treatment strategies and 3) implementing the various strategies South Africa has committed to increase the involvement of men and boys in achieving gender equality, including full participation in AIDS related home and community based care.

The Arab Women's Network "ROA" meaning ‘Vision', held a session called ‘Occupations in the Arab region contribute to maintaining Gender Inequalities'. The panel of women from Jordan, Lebanon, Iraq and Palestine described the impossibility of working for women's rights and the alleviation of women's suffering in an area of endless conflict.

One of my main frustrations with the UN system has been the lack of reliable data collection and analysis on gender. Research and analysis is key to promoting women’s rights- they are the foundation of quality advocacy and efforts- providing justification for funding, measuring impact and directing programming.

There are a couple primary challenges to strong data and analysis at the UN. First of all, the number of coordinating agencies means that any data collection and assessment processes prompt turf wars and information ownership issues. Such divisions exist within (for example between the mission level offices and those at headquarters) as well as between agencies (in the example of UN-INSTRAW, UNIFEM, and DAW.)

These are big challenges- but a number of small steps are being taken towards improvement- a few of which are being highlighted by the CSW. Regarding data collection, the DAW held a real time launch of UN Database on Sexual Violence, the culmination of a two-year project to systematically collect ad report member state information on Sexual violence. The database is made up of information on member state programming on sexual violence- including prevention, protection and response. It’s a strong venture, but will be completely dependent on the willingness of member states to report credible and useful information. Another advancement worth mentioning is UNIFEM’s report on the Progress of the World’s Women, which in 2008/2009 considered the subject: “Who Answers to Women: Gender and Accountability.” The report launched at CSW and is a highly empirical, precise document.

Improving and institutionalizing data collection and analysis should continue to be the goal of the UN Gender collective; it advances not only the UN’s mission but the larger mission of making the case for women’s equality around the world. To achieve this goal the UN should engage in more proactive partnerships to advance their research capacities. An excellent example of this occurred in the partnership with the Inter Parliamentary Union, which this week pioneered very forward thinking research on women and political participation. My second is for the NGO, academic and donor communities to continue to demand better data and analysis from the UN. If achieved, these goals will prioritize the issue of research during a crucial time in the reshaping of the UN’s gender apparatus.

I was abroad when the global finical crisis struck and thus keenly aware of its reverberating and devastating effects. I assumed the news for financing gender equitable programming would prove equally bleak. While my knowledge of global finance is limited, I assumed that a tightening in the developed world would decrease development dollars abroad- meaning less money and opportunities for women.  Events early on during the CSW seemed to hold up my assumptions- Navi Pillay, the U.N. High Commissioner for Human Rights reflected that the “negative effects of the financial crisis will be felt disproportionably in developing and least developed countries, the poorest of the world's poor.” She sighted the vulnerability of women to losses in employment, shelter and food and the likelihood that the girl child would forfeit education to assist her family in the home.

However, at the CSW workshop “Financial Crisis: Policy Options and Priorities”, Barbra Adams of the Global Policy Forum brought context to the discussion with a reminder that issues of gender inequality greatly preceded the finical crisis. Creating options for addressing fiscal inequality has been an ongoing issue of concern- illustrated by the fact that ‘Financing for Development’ was a priority theme at the 52^nd CSW. That being said, the panel suggested that the global financial crisis was actually an opportunity for national governments to create more ‘fiscal space’ for women through raising and spending of public funding on programs that effect them. Panelists suggested that national governments are now willing to pump money into social development as a means for revving the economy- and social development money is likely to promote and advance women.

The crisis as opportunity lens made me consider my own work on post conflict countries such as Afghanistan- during which I had found that the instability and lack of economic institutions within the post conflict phase provided a window of opportunity to promote gender equality (which would aid in stabilizing society.) Studies from the Nadereh Chamlou at the World Bank and Isobel Coleman of the Council on Foreign Relations prove that women’s economic participation raises economic development, crucial to overall development and stabilization, by decreasing the dependency ratio- as it correlates with decreasing birth rates. Women are also significantly more likely than men to reinvest their earnings in items which benefit the family.  Finally, the presence of women in institutions- such as fiscal and administrative bureaucracies- is associated with decreases in corruption, something greatly needed in the wake of a greed driven fiscal meltdown.

Risks to women during this crisis are indeed high- however in shifting our frame of reference we shed light on a great opportunity for change. As nation states and international organizations respond to this crisis, we should organize and lobby for renewed and increased investments in women and girls at the national and international level (including during the high level meeting on the topic at the UNHQ in June.) As Rachel Mayanja, U.N. Special Adviser on Gender, pointed out- investing in women and girls is “not only good for them, but also for men and boys;” perhaps it will also be good the world as a whole.

Forced sterilization is not something you hear a lot about today, as if it were some relic from a dark chapter in history. Yet, sterilization without a woman’s knowledge or consent continues to be a chilling reality for some of the world’s most marginalized women, such as those living with HIV.

I recently attended a session at the Commission on the Status of Women entitled “Beyond Denial and Discomfort: Securing the Rights and Health of Women and Youth, including those Who Live with HIV,” co-sponsored by the Center for Health and Gender Equity, International Women’s Health Coalition, International Planned Parenthood Federation- Western Hemisphere Region, and the Center for Reproductive Rights. Speakers discussed the blatant discrimination and denial of reproductive choices for many women living with HIV and how women are raising their voices to reclaim basic human rights.

Esther Sheehama, a young woman from Namibia, spoke courageously about living with HIV and the pain of discovering she had been sterilized without knowing, "It’s not easy growing up as a young, HIV-positive woman.  There is so much stigma, discrimination and name-calling.  They call me ‘AIDS-face.’” During a family planning visit several years after giving birth, Esther found out she had been sterilized after delivery: “My right to motherhood was violated.  It’s very painful knowing that I cannot carry a child for my future husband.”

Another haunting story was shared by Vasili Deliyanis, director of Vivo Positivo in Chile.  He spoke of a Chilean HIV-positive woman who was also sterilized without her knowledge or authorization.  Francisca (not her real name) tested positive while pregnant and received scant information or counseling about her health.  The state hospital where she gave birth performed a tubal litigation after her caesarean delivery, without discussing the possibility of a surgical sterilization or asking for her consent.

Both Esther and Vasili spoke to a persistent attitude among some health professionals that HIV-positive women should not have sex or children because “having sex endangers the health of their male partners” or “having children is irresponsible because they will get HIV or the mother will die.”

Yet, we know that positive women can and do lead fulfilling, safe and pleasurable sex lives.  And women living with HIV who have access to prevention of mother-to-child transmission services like ARVs can give birth to healthy infants. Increased access to treatment has allowed women and men to live long and satisfying lives.

Their stories pointed to what’s really at stake: respect for fundamental human rights of all women, regardless of HIV status, including the right to make choices about reproduction free of discrimination, coercion and violence, and the right to attain the highest standard of sexual and reproductive health.

Both Esther and Vasili are pushing hard for the recognition of these rights.  Esther is involved in peer education with young women in Senegal, and is unabashed about sharing her story.  And Vasili’s organization and the Center for Reproductive Rights have filed a complaint against Chile on behalf of Francisca before the Inter-American Commission on Human Rights.

Edinah Masiyiwa, executive director of Women’s Action Group (WAG) in Zimbabwe, was the final speaker and tied Esther and Vasili’s stories together by underscoring the need for programs that take comprehensive approaches to sexual and reproductive health and rights, like those at WAG.  Such programs are critical in fighting HIV and AIDS because they address the holistic needs of women and men, regardless of HIV status, without stigma and discrimination.

I left the session feeling inspired that advocates are holding service providers and governments accountable for violations of reproductive rights.  But it will take wider respect for a woman’s right to make reproductive decisions, and more programs like those of WAG, before forced sterilization is truly a relic of the past.

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