Women won't wait

About the author
Susana Fried, author of the recently released Show us the money: is violence against women on the HIV donor agenda?, is one of the founders and key organizers of the Women Won't Wait: End HIV and Violence Against Women and Girls. Now campaign. She was formerly the Program Director at the International Gay and Lesbian Human Rights Commission (IGLHRC). She has written, spoken, trained and published extensively on a range of human rights concerns and has been closely affiliated with the Program for International Health and Human Rights, Harvard School of Public Health (Boston, MA); Global Rights, Partners for Justice (Washington, DC, USA); Center for Women's Global Leadership at Rutgers University (USA); and Amnesty International. Fried holds a Ph.D. in Political Economy/Gender and Development at Rutgers University.

The German presidency of the G8 has made fighting HIV and Aids in Africa a priority for the Summit at Heiligendamm this week. Leaders of the world's wealthiest countries have committed to supporting HIV/Aids prevention, treatment, and care, with the goal of coming "as close as possible" to universal access to treatment by 2010. But these lofty promises have not yet translated into dedicated funding to address a major and prevalent driver of the pandemic - the deadly intersection of HIV/Aids with violence against women and girls.

To state the obvious - violence against women and girls is a big contributor to death and illness among women, as well as to a host of human rights abuses. Moreover, gender-based violence, and particularly intimate partner violence, is a leading factor in the increasing "feminization" of the global Aids pandemic. Simultaneously, HIV/Aids is both a cause and a consequence of the gender-based violence, stigma and discrimination that women and girls face in their families and communities, in peace and in conflict, within and outside of intimate partnerships, and by state and non-state actors.

Yet agencies continue to treat HIV/Aids and violence against women and girls as separate issues - so that not only are efforts to address violence as a cause and consequence of HIV infection under-funded, but also the strategic imperative for integrating these efforts continues to suffer from a dangerous and dysfunctional split. Rather than comprehensively addressing this deadly intersection, national and global Aids responses continually fail to grapple with its implications.

The roots of the problem

Women and girls are at persistent risk of attack. According to the recent World Health Organization (WHO) multi-country study on violence against women, in 13 of their 15 study sites, one-third to three-quarters of women had been physically or sexually assaulted by an intimate partner. Violence, or the threat of it, not only causes physical and psychological harm to women and girls, it also limits their access to and participation in society because the fear of violence circumscribes their freedom of movement and of expression as well as their rights to privacy, security and health. Women and girls encounter violence in their homes, communities, schools, workplaces, streets, markets, police stations and hospitals. And women who are HIV-positive face an additional danger: the stigma and threat of violence against people living with HIV and Aids.

Women are two to four times more likely to contract HIV during unprotected sex than are men, because their physiology places them at a higher risk of injuries, because they are less able to control the circumstances and conditions of sexual intercourse, and because they are more likely than men to be at the receiving end of violent or coercive sexual intercourse. Elements of the Aids testing, treatment and prevention machinery may also bring risk, such as the danger of violence connected to disclosure of HIV positive serostatus, coercive testing in the guise of voluntary counseling and testing (VCT), or the insidious treatment of women as vectors of disease, as in the case of prevention of mother-to-child transmission programmes (PMTCT) that fail to treat pregnant HIV positive women as clients with rights, or only as, and nothing more than, child-bearers.

The discrimination and abuse faced by same sex desiring and gender non-conforming individuals is captured by the term "heteronormativity". This term is used to encompass practices used to enforce "normal" (men as 'masculine' - read assertive and in control, and women as feminine - read passive and docile) heterosexuality. Cathy Cohen has defined heteronormativity as the practices and institutions "that legitimize and privilege heterosexuality and heterosexual relationships as fundamental and "natural" within society" (2005: 24). Her work emphasizes the importance of sexuality as implicated in broader structures of power, intersecting with and inseparable from race, gender, and class oppression. See also

The impacts of both HIV/Aids and violence against women is exacerbated by inadequate services and failure to protect sexual and reproductive health and rights; laws that are weak or discriminatory toward women living with HIV/Aids; social and community standards that validate the subordination of women and all others whose sexuality and gender identity do not conform to social standards of appropriate femininity and masculinity; and the intersecting forms of discrimination faced by women and girls because of their race, language, sexuality, ethnicity, and other similar factors.

This is why national and international commitment to universal access is crucial to reversing the HIV/Aids pandemic. But only in rare instances have states fully committed to grappling with women's human rights in relation to violence or HIV/Aids. Equally rarely have donors and other multilateral agencies created structures of accountability in service of respecting, protecting and fulfilling the human rights of women and girls. The Women Won't Wait campaign's March 2007 report looked at the policy, programming and funding patterns of the five largest public HIV/Aids donors and found that strong statements of policy concern 'evaporate' at the level of implementation. The level of funding for efforts to address gender-based violence remains small and often marginalized, while the integration of violence against women programming in the much larger pot of funding for HIV/Aids is inadequate and hard to trace.

Gender-based violence continues to be treated as an "add-on" rather than as integral to work on HIV/Aids. Meanwhile, levels of funding for women's rights work are 'dismal', according to the Association for Women's Rights in Development. Violence against women and girls is rarely highlighted as a major driver and consequence of the disease, nor measured statistically to contribute to the evidence base. It is nearly impossible to determine the precise amount of money contributed to work at the intersection because none of these donors publicly track their programming for and funding to violence eradication efforts within their HIV/Aids portfolio. All this despite the fact that - as WHO Director-General Margaret Chan has said - "what gets measured gets done".

Show us the money

Real commitments on the issues of gender-based violence against women and girls and the feminization of the AIDS epidemic from member nations of the G8 are long overdue. G8 member nations must now take bold steps to demonstrate their commitment to respect, protect and fulfill women's rights - especially in the context of HIV/Aids - by promoting policies and negotiating positions that ensure adequate health care, education, legal services, and gender-sensitive and rights-based Aids and anti-violence interventions.

Women's movements throughout the world have long fought for concrete action to promote and protect the human rights of all women - including the rights to be free from violence, coercion, stigma and discrimination, and right to achieve the highest attainable standard of health, including sexual and reproductive health. But this global standard is rarely translated into policy and practice. In the case of HIV/Aids, this results in a deadly failure in policy and an abrogation of governments' and donors' accountability. The waiting must end.